Healthcare Provider Details

I. General information

NPI: 1356113658
Provider Name (Legal Business Name): AMBER JUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GOFF MOUNTAIN RD STE 3
CROSS LANES WV
25313-6600
US

IV. Provider business mailing address

314 GOFF MOUNTAIN RD STE 3
CROSS LANES WV
25313-6600
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-7070
  • Fax:
Mailing address:
  • Phone: 304-388-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number86048
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: