Provider Demographics
NPI:1891243788
Name:VICKNAIR, AMANDA (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:VICKNAIR
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-6484
Mailing Address - Country:US
Mailing Address - Phone:205-558-3484
Mailing Address - Fax:205-930-2158
Practice Address - Street 1:2910 MORGAN RD
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6484
Practice Address - Country:US
Practice Address - Phone:205-558-3484
Practice Address - Fax:205-930-2158
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010695363LF0000X
AL1-148942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily