Healthcare Provider Details

I. General information

NPI: 1982069670
Provider Name (Legal Business Name): AMANDA PEEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 S GRAND ST
MONROE LA
71202-6322
US

IV. Provider business mailing address

2318 SAUVELLE DR
MONROE LA
71201-2953
US

V. Phone/Fax

Practice location:
  • Phone: 318-324-5441
  • Fax: 318-324-5442
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: