Provider Demographics
NPI:1619413275
Name:DAVIS, AMANDA PAIGE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PAIGE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:PAIGE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:1010 1ST ST N
Mailing Address - Street 2:STE 112
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8621
Mailing Address - Country:US
Mailing Address - Phone:205-663-1023
Mailing Address - Fax:205-423-0416
Practice Address - Street 1:270 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-4040
Practice Address - Country:US
Practice Address - Phone:205-664-9430
Practice Address - Fax:205-664-1846
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-104301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily