Provider Demographics
NPI:1952149759
Name:FOX, AMANDA (PA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MARTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:193 NW 2ND ST # 259
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-7016
Mailing Address - Country:US
Mailing Address - Phone:585-734-4966
Mailing Address - Fax:
Practice Address - Street 1:4303 PITMAN ST
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4473
Practice Address - Country:US
Practice Address - Phone:580-585-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0012232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant