Healthcare Provider Details

I. General information

NPI: 1972425197
Provider Name (Legal Business Name): AMANDA GEATHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WILD TURKEY LN
QUINCY FL
32351-0582
US

IV. Provider business mailing address

110 WILD TURKEY LN
QUINCY FL
32351-0582
US

V. Phone/Fax

Practice location:
  • Phone: 850-322-7356
  • Fax:
Mailing address:
  • Phone: 850-322-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: