Provider Demographics
NPI:1063856151
Name:LIGGETT, AMANDA ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ROSE
Last Name:LIGGETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-3555
Mailing Address - Fax:208-765-1494
Practice Address - Street 1:700 W IRONWOOD DR STE 378
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4401
Practice Address - Country:US
Practice Address - Phone:208-625-3555
Practice Address - Fax:208-765-1494
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-15106207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063856151OtherTRICARE/CHAMPUS
VA1063856151OtherMULTIPLAN
VA1063856151OtherVIRGINIA PREMIER HEALTH PLAN
VA1063856151OtherUNITED HEALTHCARE
VA1063856151OtherAETNA
VA1063856151OtherHUMANA
VA1063856151OtherOPTIMA HEALTH
VA1063856151OtherVIRGINIA HEALTH NETWORK
VA1063856151OtherCORVEL
VA1063856151Medicaid
VA1063856151OtherVIRGINIA PREMIER HEALTH PLAN
VA1063856151OtherUSA MANAGED CARE
VA1063856151OtherVIRGINIA HEALTH NETWORK
VA1063856151OtherHUMANA
VA1063856151OtherAETNA
VA1063856151OtherVIRGINIA HEALTH NETWORK