Provider Demographics
NPI:1023551603
Name:DAUGHERTY, AMANDA (FNP)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 FORT CHISWELL RD
Mailing Address - Street 2:
Mailing Address - City:FORT CHISWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24360-4139
Mailing Address - Country:US
Mailing Address - Phone:276-637-6641
Mailing Address - Fax:
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3614
Practice Address - Country:US
Practice Address - Phone:615-436-9060
Practice Address - Fax:615-235-9725
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily