MEDICARE: MRS. AMANDA KIMBLE CRAWFORD CPNP

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	363LP0200X	Pediatric Nurse Practitioner	RN096204 AP04552	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891794020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA KIMBLE CRAWFORD CPNP

Provider Business Mailing Address
First Line	:	2051 SILVERSIDE DR
Second Line	:	STE 260
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-9005
Country	:	US
Telephone Number	:	225-490-6301
Fax Number	:	225-765-9539

Provider Business Practice Location Address
First Line	:	8415 GOODWOOD BLVD
Second Line	:	STE 100
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7851
Country	:	US
Telephone Number	:	225-765-5633
Fax Number	:	225-765-5634

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/09/2015

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