MEDICARE: MS. AMANDA KAYE HOLDER R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	152140	MO
2	163W00000X	Registered Nurse	R881325	MS
3	163WI0500X	Infusion Therapy Registered Nurse	152140	MO
4	163WI0500X	Infusion Therapy Registered Nurse	R881325	MS

General Provider Information

NPI Number	:	1154554715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA KAYE HOLDER R.N.

Provider Business Mailing Address
First Line	:	7856 WESTSIDE PARK DR
Second Line	:	STE C
City	:	MOBILE
State	:	AL
Zip	:	36695-8541
Country	:	US
Telephone Number	:	251-633-8090
Fax Number	:	251-633-8864

Provider Business Practice Location Address
First Line	:	7856 WESTSIDE PARK DR
Second Line	:	STE C
City	:	MOBILE
State	:	AL
Zip	:	36695-8541
Country	:	US
Telephone Number	:	251-633-8090
Fax Number	:	251-633-8864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	08/31/2009

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