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General NPI Number Information
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NPI Number | 1083040562
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Entity Type | Individual
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Provider Name | AMANDA B GREENE DNP, NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 625 S PEAR ORCHARD RD STE B
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City | RIDGELAND
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State | MS
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Zip | 39157-4836
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Country | US
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Telephone | 601-499-0282
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Fax | 601-499-0347
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Provider Business Mailing Address
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Address Line | 625 S PEAR ORCHARD RD STE B
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City | RIDGELAND
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State | MS
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Zip | 39157-4836
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Country | US
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Telephone | 601-499-0282
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Fax | 601-499-0347
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 870536
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 870536
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License Number State | MS
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