Provider Demographics
NPI:1831783000
Name:RIGGINS, AMANDA SUE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SUE
Last Name:RIGGINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUE
Other - Last Name:BAUSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST STE 480W
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 S 8TH ST STE 301E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2403
Practice Address - Country:US
Practice Address - Phone:270-762-1539
Practice Address - Fax:270-752-2858
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29003363LF0000X
KY3017692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ067990Medicaid
KY7100846930Medicaid