Individual
MS. AMANDA NICOLE HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
6510 HIGHWAY 90 STE A, GAUTIER, MS 39553-5015
(228) 822-6148
Mailing address
6510 HIGHWAY 90 STE A, GAUTIER, MS 39553-5015
(228) 822-6148
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R875468
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
087588233
—
MS
01
—
385845YSCQ
MEDICARE PTAN
MS
Enumeration date
01/11/2013
Last updated
04/24/2023
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