Healthcare Provider Details

I. General information

NPI: 1003362765
Provider Name (Legal Business Name): AMANDA D MARSHBURN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 RICHLANDS HWY
RICHLANDS NC
28574-7198
US

IV. Provider business mailing address

701 DOCTORS DR
KINSTON NC
28501-1589
US

V. Phone/Fax

Practice location:
  • Phone: 910-324-7328
  • Fax: 910-324-7329
Mailing address:
  • Phone: 252-559-2200
  • Fax: 252-522-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201339
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5008952
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5008952
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: