Provider Demographics
NPI:1669113403
Name:SEABOLT, AMANDA M (PHD, PMHNP-BC, RN)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:SEABOLT
Suffix:
Gender:F
Credentials:PHD, PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:OH
Mailing Address - Zip Code:43540-9703
Mailing Address - Country:US
Mailing Address - Phone:419-266-5251
Mailing Address - Fax:
Practice Address - Street 1:271 MAPLE ST
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:OH
Practice Address - Zip Code:43540-9703
Practice Address - Country:US
Practice Address - Phone:419-266-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.393970163WG0000X
OHAPRN.CNP.0038240363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice