Provider Demographics
NPI:1821387069
Name:SMITH, AMANDA ROGERS (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROGERS
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2330 UNIVERSITY BLVD
Mailing Address - Street 2:STE 501
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1599
Mailing Address - Country:US
Mailing Address - Phone:205-344-9019
Mailing Address - Fax:205-344-9031
Practice Address - Street 1:2700 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3360
Practice Address - Country:US
Practice Address - Phone:205-344-9019
Practice Address - Fax:205-344-9031
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner