MEDICARE: AMANDA KAY PETTY FNP-BC

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	363L00000X	Nurse Practitioner	APRN-NP312903	GA

General Provider Information

NPI Number	:	1841130812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KAY PETTY FNP-BC

Provider Business Mailing Address
First Line	:	2917 STOVALL RD
Second Line	:
City	:	ALMA
State	:	GA
Zip	:	31510-4013
Country	:	US
Telephone Number	:	912-288-4409
Fax Number	:

Provider Business Practice Location Address
First Line	:	283 WALNUT ST
Second Line	:
City	:	BAXLEY
State	:	GA
Zip	:	31513-0954
Country	:	US
Telephone Number	:	855-473-4374
Fax Number	:

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	05/06/2026

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