MEDICARE: AMANDA SHARRELL THOMAS APN-CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209026382	IL
2	367500000X	Certified Registered Nurse Anesthetist	AP142047	TX
3	367500000X	Certified Registered Nurse Anesthetist	R103706	AR

General Provider Information

NPI Number	:	1275196065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SHARRELL THOMAS APN-CRNA

Provider Business Mailing Address
First Line	:	1 WILLOW CREEK LN APT 1111
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-8098
Country	:	US
Telephone Number	:	972-821-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WILLOW CREEK LN APT 1111
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-8098
Country	:	US
Telephone Number	:	972-821-8885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2019
Last Update Date	:	03/11/2026

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