Individual
AMY FORSYTHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5220
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5220
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R857964
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07628011
—
MS
05
—
1722189
—
LA
01
—
302I509755
MEDICARE PTAN
MS
Enumeration date
09/22/2006
Last updated
06/14/2012
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