Healthcare Provider Details

I. General information

NPI: 1801611405
Provider Name (Legal Business Name): AMANDA L LYBARGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

IV. Provider business mailing address

2074 S 6TH ST
KLAMATH FALLS OR
97601-3372
US

V. Phone/Fax

Practice location:
  • Phone: 541-841-8110
  • Fax: 841-885-5512
Mailing address:
  • Phone: 541-841-8110
  • Fax: 841-885-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10035575
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: