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NPI Code Detail

MEDICARE: AMELIA J WHIDDON CRNA

MEDICARE: AMELIA J WHIDDON 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
1367500000XCertified Registered Nurse Anesthetist1044400AL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00156296OTHERALRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1510-78519OTHERALBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528043684
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMELIA J WHIDDON CRNA
Provider Business Mailing Address
First Line : PO BOX 1547
Second Line :
City : SEDALIA
State : MO
Zip : 65302-1547
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Provider Business Practice Location Address
First Line : 29 L V STABLER DR
Second Line :
City : GREENVILLE
State : AL
Zip : 36037-3850
Country : US
Telephone Number : 334-383-2210
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 10/23/2013

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