Provider Demographics
NPI:1598455248
Name:SMITH, AMANDA N
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E GRAFTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4465
Mailing Address - Country:US
Mailing Address - Phone:304-366-5832
Mailing Address - Fax:
Practice Address - Street 1:14 E GRAFTON RD STE C
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4465
Practice Address - Country:US
Practice Address - Phone:304-366-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator