Healthcare Provider Details

I. General information

NPI: 1801824982
Provider Name (Legal Business Name): AMANDA R GORECKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA C ROSE CNP

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 BARNES RD
LOOKOUT MOUNTAIN GA
30750-4108
US

IV. Provider business mailing address

299 BARNES RD
LOOKOUT MOUNTAIN GA
30750-4108
US

V. Phone/Fax

Practice location:
  • Phone: 316-761-2708
  • Fax:
Mailing address:
  • Phone: 316-761-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP212379
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: