Provider Demographics
NPI:1407571771
Name:WHITE, AMANDA LESHEA
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LESHEA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4618
Mailing Address - Country:US
Mailing Address - Phone:662-841-2476
Mailing Address - Fax:
Practice Address - Street 1:130 S INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4618
Practice Address - Country:US
Practice Address - Phone:662-841-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter