Ametha Broadwater, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

0002070904 Issued in VA

Practice address

151 Reedy St
Bristol, VA 24201-3126

Phone

(423) 646-1560

NPI assigned

Jul 26, 2012

Last updated

Jul 26, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Heavenly Hands Healthcare, LLC

  • Home Health Agency
  • Bristol, VA
  • NPI 1124374236
  NPD (past) Authorized official

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

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1669728754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 REEDY ST",
            "city": "BRISTOL",
            "state": "VA",
            "postal_code": "242013126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 REEDY ST",
            "city": "BRISTOL",
            "state": "VA",
            "postal_code": "242013126",
            "telephone_number": "423-646-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWATER",
        "first_name": "AMETHA",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-26",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "VA",
            "license": "0002070904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bristol Regional Speech & Hearing Center
• Bristol Regional Speech & Hearing Center
• Bristol Therapy Services LLC (Preston Square Rehab & Wellness)
• Bristol Virginia Public Schools
• Shauna Britt
• Jordan M Brooks, PA-C
• Stephanie Lynese Brooks, LCSW
• Jessica P. Brown, M.S. CCC-SLP
• Amy Browning, COTA
• Buntings Drug Center LLC (Buntings and Northside Drug Center)

• Licensed Practical Nurse in Bristol, VA
• Providers in Bristol, VA by specialty
• Licensed Practical Nurse in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; 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.