{"npi":"1629683230","type":"NPI-1","status":"active","name":{"display":"Mrs. Amanda Phelps PA-C","other":[{"code":"1","type":"Formerly known as","value":"SIMMONS, AMANDA RENAE"}],"first":"AMANDA","last":"PHELPS","middle":"R","credential":"PA-C"},"specialty":{"primary_taxonomy":"363AM0700X","primary_taxonomy_description":"Medical Physician Assistant","slug":"medical-physician-assistant","schema_org_specialty":null,"all":[{"code":"363AM0700X","description":"Medical Physician Assistant","primary":true,"state":"LA","license":"324297"}]},"addresses":[{"purpose":"LOCATION","street_1":"3217 MABEL ST","city":"SHREVEPORT","state":"LA","postal_code":"711034022","country_code":"US","phone":"3186319121","fax":"3186319126"},{"purpose":"MAILING","street_1":"3217 MABEL ST","city":"SHREVEPORT","state":"LA","postal_code":"711034022","country_code":"US","phone":"3186319121","fax":"3186319126"}],"license":{"state":"LA","number":"324297"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"2539141","state":"LA","issuer":null},{"type_code":"01","label":"Other","value":"324297","state":"LA","issuer":"PHYSICIAN ASSISTANT LICENSURE"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20201001000281","type_code":"14-97","type_desc":"PRACTITIONER - PHYSICIAN ASSISTANT","state":"LA","pac_id":"1951720549"}]},"enumeration_date":"2020-09-10","last_updated":"2022-09-15","_meta":{"source":"NPPES","snapshot_date":"2022-09-15","doc_url":"https://findmynpi.com/api"}}