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General NPI Number Information
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NPI Number | 1457706434
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Entity Type | Individual
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Provider Name | AMANDA DAGGETT MD
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Gender | Female
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 113 W JACKSON ST STE 2C
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City | RIDGELAND
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State | MS
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Zip | 39157-2402
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Country | US
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Telephone | 601-607-8222
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Fax | 601-914-4804
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 920-663-9008
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Fax | 920-684-1439
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 321999
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 01084596A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 30216
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License Number State | MS
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