Healthcare Provider Details

I. General information

NPI: 1467905901
Provider Name (Legal Business Name): AMANDA CHRISTEN CALLOWAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 COUNTY SERVICES DR
PELHAM AL
35124-6149
US

IV. Provider business mailing address

PO BOX 846
PELHAM AL
35124-0846
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-2470
  • Fax: 205-664-4148
Mailing address:
  • Phone: 205-685-4153
  • Fax: 205-664-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1-137271
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: