Basic Information
| Provider Information | |||||||||
| NPI: | 1710641618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVALOS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Credential: | FNP-C, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 BRIARPARK DR STE 575 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770423776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326262842 | ||||||||
| FaxNumber: | 8326262842 | ||||||||
| Practice Location | |||||||||
| Address1: | 14211 POTRANCO RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782532130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817838162 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2021 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1056015 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 1056015 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.