Provider Demographics
NPI:1376724849
Name:CRIBBS, AMANDA MYRICK (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MYRICK
Last Name:CRIBBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:MYRICK
Other - Last Name:CRIBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:133 RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2064
Mailing Address - Country:US
Mailing Address - Phone:601-825-4429
Mailing Address - Fax:
Practice Address - Street 1:133 RIDGE CV
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2064
Practice Address - Country:US
Practice Address - Phone:601-825-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861360367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I438557Medicare PIN