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Individual

MRS. AMANDA JODY JOHNSON-KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DNP, FNP-BC

Contact information

Practice address
1905 S ADAMS ST, FULTON, MS 38843-8738
(662) 862-2165
(662) 862-6882
Mailing address
PO BOX 704, FULTON, MS 38843-0704
(662) 862-2165
(662) 862-6882

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R850493
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02639231
MS
01
25D0967349
CLIA
Enumeration date
09/15/2006
Last updated
06/06/2016
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