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1619791381 NPI number — AMANDA CHRISTINE WILBOURN FNP

NPI Number: 1619791381
Health Care Provider/Practitioner: AMANDA CHRISTINE WILBOURN FNP

Information about “1619791381” NPI (AMANDA CHRISTINE WILBOURN FNP) exists in 1619791381 in HTML format HTML  |  1619791381 in plain Text format TXT  |  1619791381 in PDF (Portable Document Format) PDF  |  1619791381 in an XML format XML  formats.

NPI Number : 1619791381 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619791381",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILBOURN",
    "FirstName": "AMANDA",
    "MiddleName": "CHRISTINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6 MELHANA DR SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CARTERSVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30120-8232",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 MARKET PLACE BLVD STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CARTERSVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30121-8716",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-386-7253",
    "PracticeLocationAddressFaxNumber": "678-581-7179",
    "EnumerationDate": "11/11/2024",
    "LastUpdateDate": "10/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "APRN-NP230090",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "APRN-NP230090",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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