Individual
AMY WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501 MARSHALL ST STE 104, JACKSON, MS 39202-1663
(601) 969-6404
(601) 973-4541
Mailing address
965 RIDGE LAKE BLVD STE 103, MEMPHIS, TN 38120-9446
(901) 227-3255
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902194
MS
Other
Enumeration date
10/19/2017
Last updated
03/12/2018
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