Individual
AMY O'DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3411 W MAIN ST, TUPELO, MS 38801-9413
(662) 844-9376
(662) 844-4326
Mailing address
3411 W MAIN ST, TUPELO, MS 38801-9413
(662) 844-9376
(662) 844-4326
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R857611
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03500366
—
MS
Enumeration date
12/01/2014
Last updated
05/26/2016
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