Provider Demographics
NPI:1225673965
Name:BUFFKIN, AMANDA KAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:BUFFKIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N BENT ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2712
Mailing Address - Country:US
Mailing Address - Phone:307-764-4107
Mailing Address - Fax:
Practice Address - Street 1:128 N BENT ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2712
Practice Address - Country:US
Practice Address - Phone:307-764-4107
Practice Address - Fax:307-764-1879
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY44430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily