Basic Information
Provider Information
NPI: 1316502255
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAMMOND
FirstName: AMANDA
MiddleName: BETH
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 5450 FRANTZ RD STE 360
Address2:  
City: DUBLIN
State: OH
PostalCode: 430164141
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 111 S GRANT AVE STE 350
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432154701
CountryCode: US
TelephoneNumber: 6145339550
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/07/2019
LastUpdateDate: 06/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/25/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XAPRN.CNP.025121OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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