Provider Demographics
NPI:1114171469
Name:SIMMONS, AMANDA L (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1818 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2869
Mailing Address - Country:US
Mailing Address - Phone:540-450-0072
Mailing Address - Fax:
Practice Address - Street 1:1818 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2869
Practice Address - Country:US
Practice Address - Phone:540-450-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00676827OtherMEDICARE RR
VA1114171469Medicaid
WV3810013805Medicaid
VAP00676827OtherMEDICARE RR