MEDICARE: DR. AMANDA B GREENE DNP, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	870536	MS
2	2084N0400X	Neurology Physician	870536	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01627831	OTHER	MS	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083040562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA B GREENE DNP, NP-C

Provider Business Mailing Address
First Line	:	625 S PEAR ORCHARD RD
Second Line	:	STE B
City	:	RIDGELAND
State	:	MS
Zip	:	39157-4836
Country	:	US
Telephone Number	:	601-499-0282
Fax Number	:	601-499-0347

Provider Business Practice Location Address
First Line	:	625 S PEAR ORCHARD RD
Second Line	:	STE B
City	:	RIDGELAND
State	:	MS
Zip	:	39157-4836
Country	:	US
Telephone Number	:	601-499-0282
Fax Number	:	601-499-0347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	09/16/2020

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