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NPI Code Detail

MEDICARE: AMANDA ALLRED FNP-C

MEDICARE: AMANDA ALLRED FNP-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
1363L00000XNurse Practitioner904040MS

General Provider Information

NPI Number : 1275145781
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA ALLRED FNP-C
Provider Business Mailing Address
First Line : 874 BARNES CROSSING ROAD
Second Line :
City : TUPELO
State : MS
Zip : 38804-0909
Country : US
Telephone Number : 662-841-0002
Fax Number : 662-269-6346
Provider Business Practice Location Address
First Line : 1207 HIGHWAY 182 W
Second Line :
City : STARKVILLE
State : MS
Zip : 39759-9013
Country : US
Telephone Number : 662-320-7800
Fax Number : 662-320-7797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2020
Last Update Date : 04/05/2024

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