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General NPI Number Information
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NPI Number | 1538827860
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Entity Type | Individual
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Provider Name | AMANDA ELLIS NP
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Gender | Female
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 3635 BIENVILLE BLVD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-5711
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Country | US
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Telephone | 228-872-1951
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Fax |
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Provider Business Mailing Address
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Address Line | 2909 SHELL LANDING BLVD
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City | GAUTIER
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State | MS
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Zip | 39553-5835
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 888645
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 906495
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 888645
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License Number State | MS
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