Individual
AMANDA FOLSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
340 STATELINE RD W, SOUTHAVEN, MS 38671-1610
(662) 985-0625
Mailing address
340 STATELINE RD W, SOUTHAVEN, MS 38671-1610
(662) 985-0625
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
30471
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
53-83076-121
KS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
903658
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
C-APN.0004297-C-NP
CO
Other
Enumeration date
06/15/2020
Last updated
04/16/2024
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