Basic Information
Provider Information | |||||||||
NPI: | 1154554715 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOLDER | ||||||||
FirstName: | AMANDA | ||||||||
MiddleName: | KAYE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | R.N. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7856 WESTSIDE PARK DR | ||||||||
Address2: | STE C | ||||||||
City: | MOBILE | ||||||||
State: | AL | ||||||||
PostalCode: | 366958541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2516338090 | ||||||||
FaxNumber: | 2516338864 | ||||||||
Practice Location | |||||||||
Address1: | 7856 WESTSIDE PARK DR | ||||||||
Address2: | STE C | ||||||||
City: | MOBILE | ||||||||
State: | AL | ||||||||
PostalCode: | 366958541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2516338090 | ||||||||
FaxNumber: | 2516338864 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2009 | ||||||||
LastUpdateDate: | 08/31/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 152140 | MO | Y |   | Nursing Service Providers | Registered Nurse |   | 163W00000X | R881325 | MS | N |   | Nursing Service Providers | Registered Nurse |   | 163WI0500X | 152140 | MO | N |   | Nursing Service Providers | Registered Nurse | Infusion Therapy | 163WI0500X | R881325 | MS | N |   | Nursing Service Providers | Registered Nurse | Infusion Therapy |
No ID Information.