Individual
MS. AMANDA LUSK KIDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-AG
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
1906 BELLEVIEW AVE SE, PO BOX 13367, ROANOKE, VA 24014-1838
(540) 981-7000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001199884
VA
363LA2100X
Acute Care Nurse Practitioner
Primary
0024172026
VA
363LA2200X
Adult Health Nurse Practitioner
0024172026
VA
363LG0600X
Gerontology Nurse Practitioner
0024172026
VA
Other
Enumeration date
12/17/2014
Last updated
12/17/2014
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