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General NPI Number Information
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NPI Number | 1912747668
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Entity Type | Individual
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Provider Name | AMANDA BENTLEY FNP
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Gender | Female
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 6402 MILLERS RUN BACK RUN RD
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City | LUCASVILLE
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State | OH
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Zip | 45648-8726
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Country | US
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Telephone | 740-370-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 6402 MILLERS RUN BACK RUN RD
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City | LUCASVILLE
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State | OH
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Zip | 45648-8726
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Country | US
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Telephone | 740-370-8884
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Fax | 740-212-8511
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0036560
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License Number State | OH
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