Individual
AMANDA DEGNAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
919 FERNCLIFF CV STE 1, SOUTHAVEN, MS 38671-2402
(662) 205-5045
(844) 444-1263
Mailing address
919 FERNCLIFF CV STE 1, SOUTHAVEN, MS 38671-2402
(662) 205-5045
(844) 444-1263
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
906654
MS
Other
Enumeration date
04/29/2024
Last updated
01/12/2026
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