Amanda Divine
Individual provider Active NPI Case Management Registered Nurse · Ranson, WV
NPI 1124957667 · NPPES record last updated May 19, 2026
Key facts
- NPI
- 1124957667
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Management Registered Nurse 163WC0400X
- License
- 101997 (WV)
- Practice address
- 71 Fuzzy Tail Dr
Ranson, WV 25438-4877 - Phone
- (304) 350-9975
- NPI assigned
- May 19, 2026
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Registered Nurse | 163WC0400X | 101997 | WV | Yes |
Addresses
Primary practice location
71 Fuzzy Tail Dr
Ranson, WV 25438-4877
Mailing address
71 Fuzzy Tail Dr
Ranson, WV 25438-4877
Phone (304) 350-9975
Other providers in Ranson, WV
- County of Jefferson
- Vikram Dayal
- Baolian Deng
- Kelly Sue Deronda
- Karina Diamond
- Anthony Dix
- Deborah Lynn Dix
- Jamie Lynn Dunn
- East Mountain Health Physicians Inc.
- East Mountain Health Physicians, Inc.
All providers in Ranson, WV · Case Management Registered Nurse in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.