Provider Demographics
NPI:1164869954
Name:PYBUS, AMANDA WEST (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:WEST
Last Name:PYBUS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 2266
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-2266
Mailing Address - Country:US
Mailing Address - Phone:334-305-0400
Mailing Address - Fax:334-305-0401
Practice Address - Street 1:1450 ROSS CLARK CIR STE 400
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4770
Practice Address - Country:US
Practice Address - Phone:334-305-0400
Practice Address - Fax:334-305-0401
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-123055OtherALABAMA LICENSE
AL156967Medicaid
AL102I503675Medicare PIN