Healthcare Provider Details

I. General information

NPI: 1154144194
Provider Name (Legal Business Name): AMANDA HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE STE 700
CHARLESTON WV
25304-1230
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 700
CHARLESTON WV
25304-1230
US

V. Phone/Fax

Practice location:
  • Phone: 304-351-1600
  • Fax: 304-351-1604
Mailing address:
  • Phone: 304-351-1699
  • Fax: 304-351-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number109439
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number109439
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: