Healthcare Provider Details

I. General information

NPI: 1447640321
Provider Name (Legal Business Name): AMANDA BOYD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 LAKESHORE DR STE 150
BIRMINGHAM AL
35209-8803
US

IV. Provider business mailing address

2204 LAKESHORE DR STE 170
BIRMINGHAM AL
35209-6729
US

V. Phone/Fax

Practice location:
  • Phone: 205-871-6926
  • Fax: 205-871-7981
Mailing address:
  • Phone: 205-397-4783
  • Fax: 205-868-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-112941
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: