Provider Demographics
NPI:1164000105
Name:ARCENEAUX, AMANDA MICHELLE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:ARCENEAUX
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:MICHELLE
Other - Last Name:MCINNISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:834 GRAND RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1287
Mailing Address - Country:US
Mailing Address - Phone:205-261-9344
Mailing Address - Fax:
Practice Address - Street 1:1004 1ST ST N STE 270
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8798
Practice Address - Country:US
Practice Address - Phone:205-620-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135639163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse