Provider Demographics
NPI:1477011641
Name:CLOUGHER, AMANDA DAWN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:DAWN
Last Name:CLOUGHER
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 1:15700 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-2029
Mailing Address - Country:US
Mailing Address - Phone:804-720-2585
Mailing Address - Fax:
Practice Address - Street 1:301 JENNICK DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-4904
Practice Address - Country:US
Practice Address - Phone:804-524-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily