1215209986 NPI number — MRS. AMANDA L FREEMAN FNP

Table of content: MRS. AMANDA L FREEMAN FNP (NPI 1215209986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215209986 NPI number — MRS. AMANDA L FREEMAN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
AMANDA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215209986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
951 MATTHEW DRIVE
Provider Second Line Business Mailing Address:
SUITE# A
Provider Business Mailing Address City Name:
WAYNESBORO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-371-2742
Provider Business Mailing Address Fax Number:
601-735-7266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 MATTHEW DRIVE
Provider Second Line Business Practice Location Address:
SUITE# A
Provider Business Practice Location Address City Name:
WAYNESBORO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-371-2742
Provider Business Practice Location Address Fax Number:
601-735-7266
Provider Enumeration Date:
01/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R781277 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R781277 . This is a "ST LICENSE NUMBER" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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