Healthcare Provider Details

I. General information

NPI: 1164000105
Provider Name (Legal Business Name): AMANDA MICHELLE ARCENEAUX CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MICHELLE MCINNISH CRNP

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 1ST ST N STE 270
ALABASTER AL
35007-8798
US

IV. Provider business mailing address

834 GRAND RESERVE DR
PELHAM AL
35124-1287
US

V. Phone/Fax

Practice location:
  • Phone: 205-620-7523
  • Fax:
Mailing address:
  • Phone: 205-261-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-135639
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-135639
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: