Healthcare Provider Details

I. General information

NPI: 1538634100
Provider Name (Legal Business Name): AMANDA STEWART BROWN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA S BROWN FNP-C

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

504 CLINTON CENTER DRIVE CBO-SUITE 4300
CLINTON MS
39056
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-4506
  • Fax:
Mailing address:
  • Phone: 601-815-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902982
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: