Individual
AMANDA BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
830 S GLOSTER ST, TUPELO, MS 38801-4934
(662) 377-4394
Mailing address
PO BOX 3294, TUPELO, MS 38803-3294
(662) 377-4394
(662) 377-7045
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R898893
MS
Other
Enumeration date
08/29/2011
Last updated
01/12/2015
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