1730568692 NPI number — AMANDA MCKENZIE CESARE CPNP, PC, PMHS

Table of content: AMANDA MCKENZIE CESARE CPNP, PC, PMHS (NPI 1730568692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730568692 NPI number — AMANDA MCKENZIE CESARE CPNP, PC, PMHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CESARE
Provider First Name:
AMANDA
Provider Middle Name:
MCKENZIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP, PC, PMHS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHIDDON
Provider Other First Name:
AMANDA
Provider Other Middle Name:
CESARE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP, PC, PMHS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730568692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 566
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMRALL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39482-0566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-467-6513
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4881 HIGHWAY 589
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMRALL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39482-4453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-336-9099
Provider Business Practice Location Address Fax Number:
601-550-6184
Provider Enumeration Date:
05/26/2015

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:  R879886 , 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: 03574867 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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