Provider Demographics
NPI:1063856151
Name:LIGGETT, AMANDA ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ROSE
Last Name:LIGGETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-3555
Mailing Address - Fax:208-765-1494
Practice Address - Street 1:700 W IRONWOOD DR STE 378
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4401
Practice Address - Country:US
Practice Address - Phone:208-625-3555
Practice Address - Fax:208-765-1494
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM15106207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063856151OtherVIRGINIA HEALTH NETWORK
VA1063856151OtherHUMANA
VA1063856151OtherVIRGINIA PREMIER HEALTH PLAN
VA1063856151OtherTRICARE/CHAMPUS
VA1063856151OtherCORVEL
VA1063856151OtherOPTIMA HEALTH
VA1063856151OtherAETNA
VA1063856151OtherUNITED HEALTHCARE
VA1063856151OtherMULTIPLAN
VA1063856151Medicaid
VA1063856151OtherVIRGINIA PREMIER HEALTH PLAN
VA1063856151OtherUSA MANAGED CARE
VA1063856151OtherVIRGINIA HEALTH NETWORK
VA1063856151OtherHUMANA
VA1063856151OtherAETNA
VA1063856151OtherVIRGINIA HEALTH NETWORK