Provider Demographics
NPI:1134648348
Name:SUMMERFORD, AMANDA BAKER (AGACNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:BAKER
Last Name:SUMMERFORD
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CHRISTINE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-533-3388
Mailing Address - Fax:256-801-6905
Practice Address - Street 1:101 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-533-3388
Practice Address - Fax:256-801-6905
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-143291363LA2100X
MO2017033836363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care