Active NPI
Amanda Phelps
- Licensed Practical Nurse
- Charleston, WV
National Provider Identifier
1912607797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN5249334
- Practice address
- 1599 2ND Ave
Charleston, WV 25387-2514 - Phone
- (304) 453-4663
- Fax
- (304) 453-1103
- NPI assigned
- Mar 9, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN5249334 | FL | Primary |
Addresses
Primary practice location
1599 2ND Ave
Charleston, WV 25387-2514
Mailing address
PO Box 20112
Charleston, WV 25362-1112
Phone (304) 453-4663
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN5249334 | FL | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678320000000",
"number": "1912607797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20112",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253621112",
"telephone_number": "304-453-4663",
"fax_number": "304-453-1103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1599 2ND AVE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253872514",
"telephone_number": "304-453-4663",
"fax_number": "304-453-1103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELPS",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-09",
"last_updated": "2023-03-09",
"certification_date": "2023-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "FL",
"license": "PN5249334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.