MEDICARE: AMANDA LOUISE CHAFIN AGPCNP

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
1	363LG0600X	Gerontology Nurse Practitioner	1117762	WV

General Provider Information

NPI Number	:	1609718378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LOUISE CHAFIN AGPCNP

Provider Business Mailing Address
First Line	:	615 TOWNSHIP ROAD 278
Second Line	:
City	:	CHESAPEAKE
State	:	OH
Zip	:	45619-7612
Country	:	US
Telephone Number	:	304-691-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 1ST AVE RM 1025
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1241
Country	:	US
Telephone Number	:	304-399-7484
Fax Number	:	304-399-7579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	06/11/2026

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