Healthcare Provider Details

I. General information

NPI: 1184586968
Provider Name (Legal Business Name): AMANDA LYNN MERCHANT PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 PRESIDENTS WAY
FORSYTH GA
31029-7369
US

IV. Provider business mailing address

266 PRESIDENTS WAY
FORSYTH GA
31029-7369
US

V. Phone/Fax

Practice location:
  • Phone: 315-350-9695
  • Fax:
Mailing address:
  • Phone: 315-350-9695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025050924
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: