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NPI Code Detail

MEDICARE: AMANDA ELLIS NP

MEDICARE: AMANDA ELLIS NP
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 Practitioner906495MS
2163W00000XRegistered Nurse888645MS
3163WC0200XCritical Care Medicine Registered Nurse888645MS
4363LC0200XCritical Care Medicine Nurse Practitioner906495MS

General Provider Information

NPI Number : 1538827860
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA ELLIS NP
Provider Business Mailing Address
First Line : 2909 SHELL LANDING BLVD
Second Line :
City : GAUTIER
State : MS
Zip : 39553-5835
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3635 BIENVILLE BLVD
Second Line :
City : OCEAN SPRINGS
State : MS
Zip : 39564-5711
Country : US
Telephone Number : 228-872-1951
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2021
Last Update Date : 04/16/2026

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Directions to “ AMANDA ELLIS NP” Practice Location

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