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General NPI Number Information
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NPI Number | 1356538045
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Entity Type | Individual
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Provider Name | AMANDA LEIGH MARTIN FNP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 609 BRUNSON DR STE B
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City | TUPELO
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State | MS
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Zip | 38801-4948
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Country | US
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Telephone | 662-432-1097
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Fax | 833-707-1951
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Provider Business Mailing Address
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Address Line | PO BOX 480
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City | CORINTH
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State | MS
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Zip | 38835-0480
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Country | US
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Telephone | 662-432-1097
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Fax | 833-707-1951
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R865619
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R865619
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License Number State | MS
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