Healthcare Provider Details

I. General information

NPI: 1023785854
Provider Name (Legal Business Name): AMANDA MARIE BRICKEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2021
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8655 N WRIGHT ST
CAMAS WA
98607-6709
US

IV. Provider business mailing address

8655 N WRIGHT ST
CAMAS WA
98607-6709
US

V. Phone/Fax

Practice location:
  • Phone: 530-945-9257
  • Fax:
Mailing address:
  • Phone: 530-945-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61585102
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61145537
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: