Healthcare Provider Details

I. General information

NPI: 1861890311
Provider Name (Legal Business Name): AMANDA ATITYA FOX NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 W PERIMETER RD
JB ANDREWS MD
20762-6602
US

IV. Provider business mailing address

1060 W PERIMETER RD
JB ANDREWS MD
20762-6602
US

V. Phone/Fax

Practice location:
  • Phone: 888-999-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number195098
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: