Healthcare Provider Details

I. General information

NPI: 1821427493
Provider Name (Legal Business Name): AMANDA L GRAY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 02/27/2021
Certification Date: 02/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MEDICAL CIR
WINCHESTER VA
22601-3322
US

IV. Provider business mailing address

128 MEDICAL CIR
WINCHESTER VA
22601-3322
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-8975
  • Fax: 540-667-6589
Mailing address:
  • Phone: 540-667-8975
  • Fax: 540-667-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024171195
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: