Provider Demographics
NPI:1558427997
Name:MCNEIL, AMANDA (DNP, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MCNEIL BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:150 CHARLOIS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1549
Mailing Address - Country:US
Mailing Address - Phone:336-999-9311
Mailing Address - Fax:
Practice Address - Street 1:150 CHARLOIS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1549
Practice Address - Country:US
Practice Address - Phone:336-999-9311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128333163W00000X
NC900294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP02107360OtherRR MEDICARE-LFM
NCNCM576BOtherMEDICARE PTAN-LFM
NC154YHOtherBCBS NC-BSKY
NCNCM576C190OtherMEDICARE PTAN-BLUE SKY
NCP021073090OtherRR MEDICARE-BSKY