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NPI Code Detail

MEDICARE: MRS. AMANDA LEAH BARRY ACNP

MEDICARE: MRS. AMANDA LEAH BARRY ACNP
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
1163WC0200XCritical Care Medicine Registered NurseR862034MS
2363LA2100XAcute Care Nurse Practitioner862034MS

General Provider Information

NPI Number : 1851575880
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA LEAH BARRY ACNP
Provider Business Mailing Address
First Line : 2950 CATO RD
Second Line :
City : BRAXTON
State : MS
Zip : 39044
Country : US
Telephone Number : 601-847-2754
Fax Number :
Provider Business Practice Location Address
First Line : 970 LAKELAND DR STE 61
Second Line :
City : JACKSON
State : MS
Zip : 39216-4682
Country : US
Telephone Number : 601-982-7850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2007
Last Update Date : 08/10/2023

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