Individual
AMANDA WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
104 S FRONT AVE, PRESTONSBURG, KY 41653-1614
(606) 886-8572
(606) 886-4433
Mailing address
104 S FRONT AVE, PRESTONSBURG, KY 41653-1614
(606) 886-8572
(606) 886-4433
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3003330
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000236830
BCBS PROVIDER NUMBER
—
01
—
3003330
STATE NP LICENSE
KY
05
—
78004652
—
KY
Enumeration date
09/17/2006
Last updated
10/10/2016
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