Physician Compare National (NPI:1457457814)

HEALTHCARE PROVIDER: AMANDA JODY JOHNSON-KELLY DNP, FNP-BC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1457457814
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254403942
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080714000124
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON-KELLY
	Individual professional last name
Provider First Name	AMANDA
	Individual professional first name
Provider Middle Name	JODY
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1905 S ADAMS ST
	Group Practice or individual's line 1 address
City	FULTON
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	388438738
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6628622165
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y