Provider Demographics
NPI:1619319340
Name:GOAD, AMANDA JANEL (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANEL
Last Name:GOAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 YADKIN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-8784
Mailing Address - Country:US
Mailing Address - Phone:336-777-6093
Mailing Address - Fax:
Practice Address - Street 1:157 YADKIN VALLEY RD
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-8784
Practice Address - Country:US
Practice Address - Phone:336-777-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000000363L00000X
NC5006314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner