Basic Information
Provider Information
NPI: 1538118807
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRANK
FirstName: AMY
MiddleName: JO
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16020 PARK VALLEY DR
Address2:  
City: ROUND ROCK
State: TX
PostalCode: 786813573
CountryCode: US
TelephoneNumber: 5122440766
FaxNumber: 5122441013
Practice Location
Address1: 16020 PARK VALLEY DR
Address2:  
City: ROUND ROCK
State: TX
PostalCode: 78681
CountryCode: US
TelephoneNumber: 5122440766
FaxNumber: 5122441013
Other Information
ProviderEnumerationDate: 05/06/2006
LastUpdateDate: 02/13/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA06223TXY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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