Provider Demographics
NPI:1477563104
Name:SCHIEFER, AMANDA REAGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:REAGAN
Last Name:SCHIEFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 LAKELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39126
Mailing Address - Country:US
Mailing Address - Phone:601-926-4255
Mailing Address - Fax:
Practice Address - Street 1:971 LAKELAND DR STE 450
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4615
Practice Address - Country:US
Practice Address - Phone:601-948-5158
Practice Address - Fax:601-326-4265
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19057207RE0101X
MN102491207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04628272Medicaid
MN418950000Medicaid
MN418950000Medicaid
I57447Medicare UPIN
MNP00338852Medicare ID - Type UnspecifiedRAILROAD
MN460000280Medicare ID - Type Unspecified