Provider Demographics
NPI:1730802943
Name:COLLETT, AMANDA IRENE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:IRENE
Last Name:COLLETT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:WOOTON
Mailing Address - State:KY
Mailing Address - Zip Code:41776-0813
Mailing Address - Country:US
Mailing Address - Phone:606-538-5738
Mailing Address - Fax:
Practice Address - Street 1:243 ROY CAMPBELL DR
Practice Address - Street 2:SUITE B
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9485
Practice Address - Country:US
Practice Address - Phone:606-439-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily