Provider Demographics
NPI:1891328621
Name:EDWARDS, AMANDA LEIGH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEIGH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:MCALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5859 POUNDING MILL BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-3718
Mailing Address - Country:US
Mailing Address - Phone:276-701-2403
Mailing Address - Fax:
Practice Address - Street 1:141 E MAIN ST STE 420
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-5085
Practice Address - Country:US
Practice Address - Phone:540-509-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily