Provider Demographics
NPI:1750042594
Name:ENDERS, AMANDA MYRICK (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MYRICK
Last Name:ENDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 THREE CHOPT RD STE D
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4643
Mailing Address - Country:US
Mailing Address - Phone:804-440-4878
Mailing Address - Fax:
Practice Address - Street 1:8901 THREE CHOPT RD STE D
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4643
Practice Address - Country:US
Practice Address - Phone:804-440-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-008749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant