Individual
AMANDA WILDER LARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
4471 LONG PRAIRIE RD # 100, FLOWER MOUND, TX 75028
(972) 362-0956
Mailing address
4471 LONG PRAIRIE RD # 100, FLOWER MOUND, TX 75028-1795
(972) 362-0956
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03432
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285113101
—
TX
05
—
285113102
—
TX
Enumeration date
02/07/2008
Last updated
10/03/2018
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