Provider Demographics
NPI:1467197434
Name:HEDGEPETH, AMANDA COBB (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:COBB
Last Name:HEDGEPETH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1825
Mailing Address - Country:US
Mailing Address - Phone:757-755-5863
Mailing Address - Fax:
Practice Address - Street 1:31 RIDGE RD
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1825
Practice Address - Country:US
Practice Address - Phone:757-755-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002078820164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse