Ametha Broadwater, LPN
Individual provider Active NPI Licensed Practical Nurse · Bristol, VA
NPI 1669728754 · NPPES record last updated Jul 26, 2012
Key facts
- NPI
- 1669728754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 0002070904 (VA)
- Practice address
- 151 Reedy St
Bristol, VA 24201-3126 - Phone
- (423) 646-1560
- NPI assigned
- Jul 26, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0002070904 | VA | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heavenly Hands Healthcare, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 0002070904 | VA | Yes |
Addresses
Primary practice location
151 Reedy St
Bristol, VA 24201-3126
Mailing address
151 Reedy St
Bristol, VA 24201-3126
Other providers in Bristol, VA
- Bristol Regional Speech & Hearing Center
- Bristol Regional Speech & Hearing Center
- Bristol Therapy Services LLC
- Bristol Virginia Public Schools
- Shauna Britt
- Jordan M Brooks
- Stephanie Lynese Brooks
- Jessica P. Brown
- Amy Browning
- Buntings Drug Center LLC
All providers in Bristol, VA · Licensed Practical Nurse in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2012. 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.