Healthcare Provider Details

I. General information

NPI: 1891233458
Provider Name (Legal Business Name): AMANDA BLAIR ROBINSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 CROSSOVER RD
TUPELO MS
38801-4944
US

IV. Provider business mailing address

PO BOX 4087
TUPELO MS
38803-4087
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-4911
  • Fax: 662-844-8275
Mailing address:
  • Phone: 662-844-4911
  • Fax: 662-844-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901952
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: