Individual
MRS. AMANDA LEE HAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP-BC, PMHNP-BC
Contact information
Practice address
611 ALCORN DR, CORINTH, MS 38834-9321
(662) 293-1160
(662) 293-4254
Mailing address
808 GANN ST, IUKA, MS 38852-1337
(662) 279-0631
(662) 293-4254
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
R855720
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
855720
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07200316
—
MS
Enumeration date
03/02/2010
Last updated
08/29/2019
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