Provider Demographics
NPI:1083040562
Name:GREENE, AMANDA B (DNP, NP-C)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:B
Last Name:GREENE
Suffix:
Gender:F
Credentials:DNP, NP-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:625 S PEAR ORCHARD RD
Mailing Address - Street 2:STE B
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4836
Mailing Address - Country:US
Mailing Address - Phone:601-499-0282
Mailing Address - Fax:601-499-0347
Practice Address - Street 1:625 S PEAR ORCHARD RD
Practice Address - Street 2:STE B
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4836
Practice Address - Country:US
Practice Address - Phone:601-499-0282
Practice Address - Fax:601-499-0347
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS870536363LA2200X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08800015Medicaid
MSP01627831OtherRAILROAD MEDICARE PTAN
MSP01627831OtherRAILROAD MEDICARE PTAN