Healthcare Provider Details

I. General information

NPI: 1942938972
Provider Name (Legal Business Name): AMANDA MERCEDES GOODSPEED FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 VT 149
WEST PAWLET VT
05775-9798
US

IV. Provider business mailing address

278 VT 149
WEST PAWLET VT
05775-9798
US

V. Phone/Fax

Practice location:
  • Phone: 802-645-0580
  • Fax:
Mailing address:
  • Phone: 802-645-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359929
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0139654
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: