Provider Demographics
NPI:1194068924
Name:PERKINS, AMANDA MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2964 KELHAM GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6715
Mailing Address - Country:US
Mailing Address - Phone:479-372-2478
Mailing Address - Fax:
Practice Address - Street 1:5336 STADIUM TRACE PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4580
Practice Address - Country:US
Practice Address - Phone:205-958-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR081462163W00000X
AL1-128896163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse