Provider Demographics
NPI:1598138505
Name:MILLER, AMANDA KIMBROUGH (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:KIMBROUGH
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:KIMBROUGH
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP-BC
Mailing Address - Street 1:6720 PATTERSON AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-282-3387
Mailing Address - Fax:804-282-3387
Practice Address - Street 1:6720 PATTERSON AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-282-3387
Practice Address - Fax:804-282-3387
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017142572363L00000X
VA363LP0808X363LP0808X
VA0024173017363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner