Provider Demographics
NPI:1538616370
Name:HUDNALL, AMANDA LEE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEE
Last Name:HUDNALL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9300
Mailing Address - Country:US
Mailing Address - Phone:304-429-6741
Mailing Address - Fax:304-746-3902
Practice Address - Street 1:700 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8571
Practice Address - Country:US
Practice Address - Phone:304-746-5300
Practice Address - Fax:304-746-3902
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN66786-PMHNP-BC363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV7446B441Medicare PIN
WVB441-GROUPMedicare PIN