Healthcare Provider Details

I. General information

NPI: 1023723053
Provider Name (Legal Business Name): AMANDA DIANE PRICE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MAIN ST
WATERLOO AL
35677-4401
US

IV. Provider business mailing address

314 MAIN ST
WATERLOO AL
35677-4401
US

V. Phone/Fax

Practice location:
  • Phone: 256-629-0033
  • Fax: 256-629-0042
Mailing address:
  • Phone: 256-629-0033
  • Fax: 256-629-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-107250
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: