Provider Demographics
NPI:1972809044
Name:BLISS, AMANDA KAYE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAYE
Last Name:BLISS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 VAN VOORHIS RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3478
Mailing Address - Country:US
Mailing Address - Phone:304-599-9400
Mailing Address - Fax:304-599-8917
Practice Address - Street 1:1197 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3478
Practice Address - Country:US
Practice Address - Phone:304-599-9400
Practice Address - Fax:304-599-8917
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006528-1133VN1006X
NY014596-1363AM0700X
WV01753363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic