Provider Demographics
NPI:1700588217
Name:MCCRARY, AMANDA N (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICI
Other - Middle Name:N
Other - Last Name:MCCRARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:44552 BAYVIEW AVE APT 26309
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7360
Mailing Address - Country:US
Mailing Address - Phone:913-231-7427
Mailing Address - Fax:
Practice Address - Street 1:1402 S GRAND BLVD # M260
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1004
Practice Address - Country:US
Practice Address - Phone:314-977-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program