Provider Demographics
NPI:1003387309
Name:PEARSON, AMANDA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:CARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:516 QUINTARD AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-5711
Mailing Address - Country:US
Mailing Address - Phone:256-741-9799
Mailing Address - Fax:256-741-9795
Practice Address - Street 1:516 QUINTARD AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5711
Practice Address - Country:US
Practice Address - Phone:256-741-9799
Practice Address - Fax:256-741-9795
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-12
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily