Individual provider Active NPI

Amanda Burgoyne, RN

  • Registered Nurse
  • Longview, WA
National Provider Identifier
1013336775
Registry record updated Apr 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN00177504 Issued in WA
Practice address
139 Talkeetna HTS PL
Longview, WA 98632-5920
Phone
(360) 560-5776
NPI assigned
Apr 10, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN00177504 WA Primary

Addresses

Primary practice location

139 Talkeetna HTS PL
Longview, WA 98632-5920

Mailing address

139 Talkeetna HTS PL
Longview, WA 98632-5920
Phone (360) 560-5776

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN00177504WAMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397088000000",
    "number": "1013336775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 TALKEETNA HTS PL",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986325920",
            "telephone_number": "360-560-5776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 TALKEETNA HTS PL",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986325920",
            "telephone_number": "360-560-5776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGOYNE",
        "first_name": "AMANDA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-10",
        "last_updated": "2014-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00177504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.