Individual
AMANDA CAROLINE IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1804 DOUGHTY CIR, WEST POINT, MS 39773-4041
(662) 495-1120
(662) 495-1152
Mailing address
1804 DOUGHTY CIR, WEST POINT, MS 39773-4041
(662) 495-1125
(662) 495-1120
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
A059544
MS
Other
Enumeration date
11/03/2008
Last updated
05/28/2009
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