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General NPI Number Information
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NPI Number | 1235940842
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Entity Type | Individual
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Provider Name | AMANDA SMITH FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 4250 S EASON BLVD
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City | TUPELO
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State | MS
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Zip | 38801-6549
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Country | US
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Telephone | 662-377-5265
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Fax |
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Provider Business Mailing Address
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Address Line | 285 COUNTY ROAD 166
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City | HOUSTON
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State | MS
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Zip | 38851-9271
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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 |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 906736
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License Number State | MS
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