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General NPI Number Information
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NPI Number | 1912220237
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Entity Type | Individual
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Provider Name | AMANDA LEE HAM ANP-BC, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 611 ALCORN DR
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City | CORINTH
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State | MS
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Zip | 38834-9321
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Country | US
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Telephone | 662-293-1160
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Fax | 662-293-4254
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Provider Business Mailing Address
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Address Line | 808 GANN ST
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City | IUKA
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State | MS
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Zip | 38852-1337
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Country | US
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Telephone | 662-279-0631
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Fax | 662-293-4254
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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 | 855720
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R855720
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License Number State | MS
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