Provider Demographics
NPI:1700354826
Name:VARNEY, AMANDA JO (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:VARNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 TOLLAGE CRK
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3305
Mailing Address - Country:US
Mailing Address - Phone:606-230-2255
Mailing Address - Fax:606-437-3001
Practice Address - Street 1:484 TOLLAGE CRK
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3305
Practice Address - Country:US
Practice Address - Phone:606-230-2255
Practice Address - Fax:606-437-3001
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV91087363LF0000X
KY3012689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700354826Medicaid
KY71000636400Medicaid
WV1700354826Medicaid