Provider Demographics
NPI:1710529953
Name:WARD, AMANDA NICOLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NICOLE
Last Name:WARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 PINTAIL LN
Mailing Address - Street 2:
Mailing Address - City:LETOHATCHEE
Mailing Address - State:AL
Mailing Address - Zip Code:36047-5033
Mailing Address - Country:US
Mailing Address - Phone:334-782-8366
Mailing Address - Fax:
Practice Address - Street 1:313 PINTAIL LN
Practice Address - Street 2:
Practice Address - City:LETOHATCHEE
Practice Address - State:AL
Practice Address - Zip Code:36047-5033
Practice Address - Country:US
Practice Address - Phone:334-782-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-110423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily