Individual provider Active NPI

Amanda Irene Wilson, FNP

  • Family Nurse Practitioner
  • Fishersville, VA
National Provider Identifier
1033474283
Registry record updated May 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024170190 Issued in VA
Practice address
51 Ivy Ridge LN
Fishersville, VA 22939-2339
Phone
(540) 245-7262
Fax
(540) 245-7054
NPI assigned
Jul 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024170190 VA Primary
Registered Nurse 163W00000X 0001205339 VA

Addresses

Primary practice location

51 Ivy Ridge LN
Fishersville, VA 22939-2339

Mailing address

PO Box 388
Fishersville, VA 22939-0388

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address amanda.wilson.1@14718.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120918000064 VA Practitioner - Nurse Practitioner 9234387259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Augusta Medical GroupGroup PAC ID 3678632544, 409 clinicians

Practice addresses (Care Compare)

53 S Medical Park Dr
Fishersville, VA 22939-2333
Phone (540) 332-5687

57 N Medical Park Dr
Fishersville, VA 22939-2353

78 Medical Ctr Dr
Fishersville, VA 22939-2332
Phone (540) 332-5595

9 S Medical Park Dr
Fishersville, VA 22939-2333
Phone (540) 245-7350

Hospital & facility affiliations

  • Augusta Health Hospital, Fishersville, VA, CCN 490018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0001205339VAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Augusta Medical Group CurrentSince Aug 1, 2012 Accepting new patients
Augusta Medical Group CurrentSince Aug 1, 2012 Accepting new patients

Locations

540 Radford Ln
Ste 250
Charlottesville, VA 22903
Phone (434) 823-7596

78 Medical Center Dr
Fishersville, VA 22939
Phone (540) 245-7216

57 N Medical Park Dr
Ste 105
Fishersville, VA 22939
Phone (540) 213-2810

53 S Medical Park Dr
Fishersville, VA 22939
Phone (540) 332-5687

70 Medical Center Cir
Ste 201
Fishersville, VA 22939
Phone (540) 221-7030

51 Ivy Ridge Ln
Fishersville, VA 22939
Phone (540) 245-7262

201 Lew Dewitt Blvd
Ste A
Waynesboro, VA 22980
Phone (540) 245-7940

1140 Keezletown Rd
Weyers Cave, VA 24486
Phone (540) 453-0040

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14718/brand/4/csg/1/fhir/r4
  • Direct secure messaging: amanda.wilson.1@14718.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683676800000",
    "number": "1033474283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 388",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229390388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 IVY RIDGE LN",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392339",
            "telephone_number": "540-245-7262",
            "fax_number": "540-245-7054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AMANDA",
        "middle_name": "IRENE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-12",
        "last_updated": "2023-05-10",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024170190",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "VA",
            "license": "0001205339",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amanda.wilson.1@14718.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address",
            "address_1": "51 Ivy Ridge Ln",
            "city": "Fishersville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "229392339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fishersville, VA

Sources for this page

Verify at the official NPI Registry.