Provider Demographics
NPI:1972840940
Name:PAGE, AMANDA KAY (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:PAGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 LEE HWY STE C
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3802
Mailing Address - Country:US
Mailing Address - Phone:540-980-9660
Mailing Address - Fax:
Practice Address - Street 1:4550 LEE HWY STE C
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3802
Practice Address - Country:US
Practice Address - Phone:540-980-9660
Practice Address - Fax:540-639-0976
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004086363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110004086Medicaid