Provider Demographics
NPI:1659726990
Name:SMEDBERG, AMANDA KASINECZ (CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KASINECZ
Last Name:SMEDBERG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CHRISTINE
Other - Last Name:KASINECZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1780 MCFARLAND BLVD N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2136
Mailing Address - Country:US
Mailing Address - Phone:205-345-7351
Mailing Address - Fax:
Practice Address - Street 1:1780 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2136
Practice Address - Country:US
Practice Address - Phone:205-345-7351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.19177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0180608Medicaid
OH0180608Medicaid