Individual
AMANDA SMITH QUARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE DIVISION OF NEPHROLOGY, JACKSON, MS 39216-4500
(601) 984-5687
(601) 984-5765
Mailing address
2500 NORTH STATE STREET, CBO-SUITE 4200, JACKSON, MS 39216-4500
(601) 815-5047
(601) 815-9596
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R862128
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02632330
—
MS
Enumeration date
10/04/2010
Last updated
09/08/2020
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