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General NPI Number Information
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NPI Number | 1689002792
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Entity Type | Individual
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Provider Name | MRS. AMANDA NICOLE HENRIE PERCIVAL
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Gender | Female
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 2921 ZELDA RD
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City | MONTGOMERY
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State | AL
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Zip | 36106-2682
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Country | US
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Telephone | 334-277-5431
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 YOUNG POINTE BLVD
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City | MONTGOMERY
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State | AL
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Zip | 36106-3070
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Country | US
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Telephone | 334-312-5683
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-131198
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License Number State | AL
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