Provider Demographics
NPI:1578953303
Name:RICHARDSON, AMANDA ELISE (PA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:ELISE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:LAUREL FORK
Mailing Address - State:VA
Mailing Address - Zip Code:24352-0009
Mailing Address - Country:US
Mailing Address - Phone:276-398-1200
Mailing Address - Fax:540-745-9293
Practice Address - Street 1:140 CHRISTIANSBURG PIKE NE
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091
Practice Address - Country:US
Practice Address - Phone:540-745-9290
Practice Address - Fax:540-745-9293
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2024-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA1124168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant