Healthcare Provider Details

I. General information

NPI: 1508309675
Provider Name (Legal Business Name): AMANDA VEAZEY RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E FORTIFICATION ST
JACKSON MS
39202-2442
US

IV. Provider business mailing address

1325 E FORTIFICATION ST
JACKSON MS
39202-2442
US

V. Phone/Fax

Practice location:
  • Phone: 601-354-4488
  • Fax: 601-914-1835
Mailing address:
  • Phone: 601-354-4488
  • Fax: 601-914-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR887176
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: