Provider Demographics
NPI:1043715675
Name:BURNS, AMANDA SUSAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SUSAN
Last Name:BURNS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 WINTERHAM DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-3806
Mailing Address - Country:US
Mailing Address - Phone:850-258-4470
Mailing Address - Fax:
Practice Address - Street 1:111 W STONE DR STE 110
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-6027
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9336675363L00000X
TNAPN0000026505363L00000X
VA0024177206363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner