Provider Demographics
NPI:1891794020
Name:CRAWFORD, AMANDA KIMBLE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KIMBLE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MECHE
Other - Last Name:KIMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2051 SILVERSIDE DR
Mailing Address - Street 2:STE 260
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9005
Mailing Address - Country:US
Mailing Address - Phone:225-490-6301
Mailing Address - Fax:225-765-9539
Practice Address - Street 1:8415 GOODWOOD BLVD
Practice Address - Street 2:STE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7851
Practice Address - Country:US
Practice Address - Phone:225-765-5633
Practice Address - Fax:225-765-5634
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN096204 AP04552363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1468789Medicaid
LAQ71437Medicare UPIN
LA247948YJA2Medicare PIN
LA3B523D279Medicare PIN