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General NPI Number Information
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NPI Number | 1851916837
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Entity Type | Individual
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Provider Name | AMANDA FOLSOM PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 340 STATELINE RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1610
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Country | US
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Telephone | 662-985-0625
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Fax |
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Provider Business Mailing Address
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Address Line | 340 STATELINE RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1610
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Country | US
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Telephone | 662-985-0625
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 53-83076-121
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 903658
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | C-APN.0004297-C-NP
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 30471
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License Number State | TN
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