Healthcare Provider Details

I. General information

NPI: 1902420458
Provider Name (Legal Business Name): AMANDA KILBURN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 WARREN RD STE 106
INDIANA PA
15701-2413
US

IV. Provider business mailing address

2340 WARREN RD STE 106
INDIANA PA
15701-2413
US

V. Phone/Fax

Practice location:
  • Phone: 724-436-7047
  • Fax:
Mailing address:
  • Phone: 724-436-7047
  • Fax: 724-788-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT020278
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT020278
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS021775
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: