Healthcare Provider Details

I. General information

NPI: 1821448762
Provider Name (Legal Business Name): AMANDA DENISE SEGSWORTH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 TEAYS VALLEY RD STE 2121
HURRICANE WV
25526-8728
US

IV. Provider business mailing address

400 ASSOCIATION DR STE 102
CHARLESTON WV
25311-1298
US

V. Phone/Fax

Practice location:
  • Phone: 304-760-7631
  • Fax: 304-757-1776
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN75861
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: