Individual
AMANDA MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6525
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6525
(601) 984-5151
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R885221
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08873041
—
MS
Enumeration date
08/13/2014
Last updated
12/12/2014
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