Healthcare Provider Details

I. General information

NPI: 1659771616
Provider Name (Legal Business Name): AMANDA EASLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8742 GOODWOOD BLVD
BATON ROUGE LA
70806-7915
US

IV. Provider business mailing address

16649 SHETLAND AVE
GREENWELL SPRINGS LA
70739-5931
US

V. Phone/Fax

Practice location:
  • Phone: 225-231-7070
  • Fax:
Mailing address:
  • Phone: 225-772-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08686
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN116548
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: