Provider Demographics
NPI:1215209986
Name:FREEMAN, AMANDA L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:LEAKESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39451-5622
Mailing Address - Country:US
Mailing Address - Phone:601-394-2381
Mailing Address - Fax:601-394-5715
Practice Address - Street 1:940 MATTHEW DR
Practice Address - Street 2:STE 8
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2522
Practice Address - Country:US
Practice Address - Phone:601-735-7145
Practice Address - Fax:601-735-7155
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR781277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR781277OtherST LICENSE NUMBER