Provider Demographics
NPI:1538783899
Name:FORD, AMANDA JOY (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JOY
Last Name:FORD
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOY
Other - Last Name:URENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2108 TEXAS AVE STE 2061
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3944
Mailing Address - Country:US
Mailing Address - Phone:318-448-1041
Mailing Address - Fax:
Practice Address - Street 1:2108 TEXAS AVE STE 2061
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3944
Practice Address - Country:US
Practice Address - Phone:318-448-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily