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General NPI Number Information
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NPI Number | 1013877612
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Entity Type | Organization
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Legal Business Name | THE MENTAL DAY PLLC
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Dates
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Enumeration Date | 11/15/2025
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Last Update Date | 11/15/2025
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Provider Practice Location Address
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Address Line | 919 FERNCLIFF CV STE 1
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City | SOUTHAVEN
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State | MS
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Zip | 38671-2402
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Country | US
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Telephone | 901-297-9122
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Fax |
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Provider Business Mailing Address
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Address Line | 6280 IVY OAKS CV
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7167
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA DEGNAN JACKSON
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Credential | PMHNP
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Telephone | 901-297-9122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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