Healthcare Provider Details

I. General information

NPI: 1174415087
Provider Name (Legal Business Name): AMANDA NICHOLE ELEY APRN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E HOSPITAL RD
FORT EISENHOWER GA
30905-0000
US

IV. Provider business mailing address

266 CHURCH ST
BLYTHE GA
30805-3408
US

V. Phone/Fax

Practice location:
  • Phone: 210-473-8162
  • Fax:
Mailing address:
  • Phone: 210-473-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06261010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: