Healthcare Provider Details

I. General information

NPI: 1164346813
Provider Name (Legal Business Name): AMANDA LYNNETTE BUMGARNER ACCNS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

5855 BREMO RD STE 309
RICHMOND VA
23226-1923
US

V. Phone/Fax

Practice location:
  • Phone: 804-909-2810
  • Fax:
Mailing address:
  • Phone: 804-287-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number0024198217
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: