MEDICARE: AMANDA EVERETT 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	363LF0000X	Family Nurse Practitioner	901511	MS

General Provider Information

NPI Number	:	1467809962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA EVERETT NP-C

Provider Business Mailing Address
First Line	:	110 TUXFORD RD
Second Line	:
City	:	STARKVILLE
State	:	MS
Zip	:	39759-4061
Country	:	US
Telephone Number	:	662-312-3188
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2212
Country	:	US
Telephone Number	:	662-370-0986
Fax Number	:

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

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	01/16/2025

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