Provider Demographics
NPI:1821583196
Name:TRENT, AMANDA HOUSTON (AGACNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:HOUSTON
Last Name:TRENT
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4381 S EASON BLVD.
Mailing Address - Street 2:STE. #203
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-377-5199
Mailing Address - Fax:667-377-5301
Practice Address - Street 1:4381 S EASON BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6557
Practice Address - Country:US
Practice Address - Phone:662-377-5199
Practice Address - Fax:662-377-5301
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902537363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care