Provider Demographics
NPI:1013414630
Name:LORD, AMANDA BUSBY (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BUSBY
Last Name:LORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-9600
Mailing Address - Country:US
Mailing Address - Phone:251-776-0688
Mailing Address - Fax:
Practice Address - Street 1:9971 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-9525
Practice Address - Country:US
Practice Address - Phone:251-660-3500
Practice Address - Fax:251-660-3501
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-131518OtherLICENSE NUMBER