Provider Demographics
NPI:1558723106
Name:HALL, AMANDA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 QUINTARD AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-5711
Mailing Address - Country:US
Mailing Address - Phone:256-741-9799
Mailing Address - Fax:
Practice Address - Street 1:516 QUINTARD AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5711
Practice Address - Country:US
Practice Address - Phone:256-741-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2017-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-120197363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics