Provider Demographics
NPI:1073936761
Name:ROSS, AMANDA KIMBERLY (AG-ANCP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KIMBERLY
Last Name:ROSS
Suffix:
Gender:F
Credentials:AG-ANCP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KIMBERLY
Other - Last Name:O'MALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:759 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1154
Mailing Address - Country:US
Mailing Address - Phone:540-459-1175
Mailing Address - Fax:
Practice Address - Street 1:1065 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1041
Practice Address - Country:US
Practice Address - Phone:540-333-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172129363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care