Organization
FIG LEAF, LLC
Active
Other names
Caledonia Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA FONDREN FNP-C (NURSE PRACTITIONER/OWNER)
(662) 855-0080
Entity
Organization
Contact information
Practice address
171 SOUTH ST, CALEDONIA, MS 39740
(662) 251-7389
Mailing address
171 SOUTH ST, CALEDONIA, MS 39740-8587
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R858548
MS
363LC1500X
Community Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851792626
NPI
—
Enumeration date
09/29/2017
Last updated
05/22/2018
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