Healthcare Provider Details

I. General information

NPI: 1245109990
Provider Name (Legal Business Name): AMANDA K VERNON-CROOKS DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41800 W 11 MILE RD STE 109
NOVI MI
48375-1818
US

IV. Provider business mailing address

41800 W 11 MILE RD STE 109
NOVI MI
48375-1818
US

V. Phone/Fax

Practice location:
  • Phone: 833-578-2763
  • Fax: 248-218-9996
Mailing address:
  • Phone: 833-578-2763
  • Fax: 248-218-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number853-84662-092
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2025028312
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: