MEDICARE: MRS. AMANDA PAIGE DAVIS CRNP

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	363LF0000X	Family Nurse Practitioner	1-104301	AL

General Provider Information

NPI Number	:	1619413275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA PAIGE DAVIS CRNP

Provider Business Mailing Address
First Line	:	1010 1ST ST N
Second Line	:	STE 112
City	:	ALABASTER
State	:	AL
Zip	:	35007-8621
Country	:	US
Telephone Number	:	205-663-1023
Fax Number	:	205-423-0416

Provider Business Practice Location Address
First Line	:	270 VILLAGE PKWY
Second Line	:
City	:	HELENA
State	:	AL
Zip	:	35080-4040
Country	:	US
Telephone Number	:	205-664-9430
Fax Number	:	205-664-1846

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

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	07/21/2017

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