Provider Demographics
NPI:1275196065
Name:THOMAS, AMANDA SHARRELL (CRNA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SHARRELL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILLOW CREEK LN APT 1111
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8098
Mailing Address - Country:US
Mailing Address - Phone:972-821-8885
Mailing Address - Fax:
Practice Address - Street 1:1 WILLOW CREEK LN APT 1111
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8098
Practice Address - Country:US
Practice Address - Phone:972-821-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR103706367500000X
IL209026382367500000X
TXAP142047367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered