Healthcare Provider Details

I. General information

NPI: 1467269035
Provider Name (Legal Business Name): AMANDA GRIZZLE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA GRIZZLE

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 DRYDEN LOOP
DRYDEN VA
24243
US

IV. Provider business mailing address

439 OVERVIEW LOOP
JONESVILLE VA
24263-7929
US

V. Phone/Fax

Practice location:
  • Phone: 276-212-4325
  • Fax:
Mailing address:
  • Phone: 276-219-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024191753
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: