Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP09471 | LA |
NPI | 1003334301 |
---|---|
Provider Name | Amanda Danielle Simpson |
First Address | Meridian, MS 39301-4158 |
Second Address | Meridian, MS 39301-4158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2017 |
Last Update Date | 07/09/2017 |