Healthcare Provider Details

I. General information

NPI: 1841130812
Provider Name (Legal Business Name): AMANDA KAY PETTY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 WALNUT ST
BAXLEY GA
31513-0954
US

IV. Provider business mailing address

2917 STOVALL RD
ALMA GA
31510-4013
US

V. Phone/Fax

Practice location:
  • Phone: 855-473-4374
  • Fax:
Mailing address:
  • Phone: 912-288-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP312903
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: