Healthcare Provider Details

I. General information

NPI: 1730369612
Provider Name (Legal Business Name): AMANDA ALISA TOWNSEND DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 DIVISION STREET SUITE C MEDICAL ANALYSIS
BILOXI MS
39530-2969
US

IV. Provider business mailing address

1025 DIVISION STREET SUITE C MEDICAL ANALYSIS
BILOXI MS
39530-2969
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-2599
  • Fax:
Mailing address:
  • Phone: 228-388-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1-139768
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number405107-COA1
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR886153
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: