Healthcare Provider Details

I. General information

NPI: 1912994260
Provider Name (Legal Business Name): AMANDA J. BLACKBURN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA J. LAWSON PA-C

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DRIVE
HUNTINGTON WV
25704
US

IV. Provider business mailing address

1540 SPRING VALLEY DRIVE HERSHEL 'WOODY' WILLIAMS VAMC
HUNTINGTON WV
25704
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6741
  • Fax: 304-429-0262
Mailing address:
  • Phone: 304-429-6741
  • Fax: 304-429-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA804
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: