Doctor Name: | DR. AMANDA KATHRYN BERETTA |
NPI Number: | 1780941419 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 3801 Scott And White Dr Killeen, TX - 765435252 |
Business Phone Number: | 2546801100 |
Business Fax Number: | 2546993835 |
Mailing Address: | Po Box 844658, DALLAS |
State: | TX |
Postal Code: | 752844658 |
Phone Number: | 2547248800 |
Fax Number: | |
NPI Enumeration Date: | 04/19/2012 |
NPI Last Update Date: | 07/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |