Healthcare Provider Details

I. General information

NPI: 1033549076
Provider Name (Legal Business Name): AMY KATHERYN CASE FNP, ADM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 JAKES TRL NW
BROOKHAVEN MS
39601-8632
US

IV. Provider business mailing address

317 JAKES TRL NW
BROOKHAVEN MS
39601-8632
US

V. Phone/Fax

Practice location:
  • Phone: 601-265-2018
  • Fax: 949-864-3748
Mailing address:
  • Phone: 601-265-2018
  • Fax: 833-455-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number870517
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number870517
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904334
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: