Provider Demographics
NPI:1588939714
Name:SMALL, AMANDA LEIGH (NP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEIGH
Last Name:SMALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7951 E MAPLEWOOD AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4758
Mailing Address - Country:US
Mailing Address - Phone:303-930-7895
Mailing Address - Fax:832-601-6018
Practice Address - Street 1:14000 E ARAPAHOE RD STE 160
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4046
Practice Address - Country:US
Practice Address - Phone:303-805-7744
Practice Address - Fax:720-851-4141
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991549-NP363LA2100X, 363LF0000X
GARN199065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57779732Medicaid
CO400256YT50Medicare PIN
CO57779732Medicaid
CO400256YQ3LMedicare PIN
CO400256YQPGMedicare PIN