Healthcare Provider Details

I. General information

NPI: 1639439094
Provider Name (Legal Business Name): AMANDA JOYCE WEISSMANN RN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JOYCE KOENIG RN-APRN

II. Dates (important events)

Enumeration Date: 05/20/2012
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 ALEXANDRIA PIKE STE B
COLD SPRING KY
41076-1792
US

IV. Provider business mailing address

24140 MEMORIAL DR
LAWRENCEBURG IN
47025-7612
US

V. Phone/Fax

Practice location:
  • Phone: 859-999-1546
  • Fax:
Mailing address:
  • Phone: 513-582-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71008640A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28207606A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1143247
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.380473
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023377
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012690
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: