Provider Demographics
NPI:1770899502
Name:ELKINS, AMANDA LAYNE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LAYNE
Last Name:ELKINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LAYNE
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1711 PEPPERELL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801
Mailing Address - Country:US
Mailing Address - Phone:334-704-0200
Mailing Address - Fax:706-571-1603
Practice Address - Street 1:1711 PEPPERELL PARKWAY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801
Practice Address - Country:US
Practice Address - Phone:334-704-0200
Practice Address - Fax:706-571-1603
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN175222363L00000X
AL1-096838363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN175222OtherSTATE OF GEORGIA, GEORGIA BOARD OF NURSING