Provider Demographics
NPI:1144283201
Name:MECKES, AMANDA JILL (CRNA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JILL
Last Name:MECKES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 790213
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0213
Mailing Address - Country:US
Mailing Address - Phone:636-549-2380
Mailing Address - Fax:314-569-5974
Practice Address - Street 1:7145 PERKINS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:78080-4322
Practice Address - Country:US
Practice Address - Phone:225-765-3111
Practice Address - Fax:225-765-3114
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05849367500000X
TN11948367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4121012OtherBCBS
LA1819581Medicaid
TN3636187Medicare ID - Type Unspecified
LA3B413CE14Medicare PIN