Individual
MRS. AMANDA WYNNE ATWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
890 LAKELAND DR, JACKSON, MS 39216-4644
(601) 200-3131
(601) 200-3109
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-3131
(601) 200-3109
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R871950
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05280758
—
MS
01
—
302I501683
MEDICARE ST DOMINIC
MS
01
—
P01198583
RAILROAD MEDICARE
MS
Enumeration date
08/05/2009
Last updated
07/17/2020
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