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NPI Code Detail

MEDICARE: MISS AMANDA ELISE RICHARDSON PA

MEDICARE: MISS AMANDA ELISE RICHARDSON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1124168VA

General Provider Information

NPI Number : 1578953303
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS AMANDA ELISE RICHARDSON PA
Provider Business Mailing Address
First Line : 16 WALNUT AVE SW
Second Line :
City : ROANOKE
State : VA
Zip : 24016-4719
Country : US
Telephone Number : 540-345-6468
Fax Number : 540-345-3204
Provider Business Practice Location Address
First Line : 140 CHRISTIANSBURG PIKE NE
Second Line :
City : FLOYD
State : VA
Zip : 24091-3742
Country : US
Telephone Number : 540-745-9290
Fax Number : 540-745-9293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2015
Last Update Date : 02/23/2026

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Directions to “ MISS AMANDA ELISE RICHARDSON PA” Practice Location

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