Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 904670 | MS |
NPI | 1083281174 |
---|---|
Provider Name | Amanda Chappell |
First Address | Brookhaven, MS 39601-3628 |
Second Address | Brookhaven, MS 39601-2653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2021 |
Last Update Date | 16/09/2021 |