Healthcare Provider Details

I. General information

NPI: 1639981830
Provider Name (Legal Business Name): AMANDA CROSS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 S MILL ST STE C
TEHACHAPI CA
93561-1678
US

IV. Provider business mailing address

276 S MILL ST STE C
TEHACHAPI CA
93561-1678
US

V. Phone/Fax

Practice location:
  • Phone: 661-365-0137
  • Fax: 661-365-0147
Mailing address:
  • Phone: 301-751-1278
  • Fax: 661-365-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: