Provider Demographics
NPI:1457528150
Name:FEATHERSTON, AMANDA TAYLOR (BGS)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:TAYLOR
Last Name:FEATHERSTON
Suffix:
Gender:F
Credentials:BGS
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:TAYLOR
Other - Last Name:HOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1526
Mailing Address - Country:US
Mailing Address - Phone:574-722-5151
Mailing Address - Fax:574-739-1414
Practice Address - Street 1:1807 SMITH ST
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1576
Practice Address - Country:US
Practice Address - Phone:574-732-1414
Practice Address - Fax:574-732-0504
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator