Provider Demographics
NPI:1851575880
Name:BARRY, AMANDA LEAH (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEAH
Last Name:BARRY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 CATO RD
Mailing Address - Street 2:
Mailing Address - City:BRAXTON
Mailing Address - State:MS
Mailing Address - Zip Code:39044
Mailing Address - Country:US
Mailing Address - Phone:601-847-2754
Mailing Address - Fax:
Practice Address - Street 1:970 LAKELAND DR STE 61
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4682
Practice Address - Country:US
Practice Address - Phone:601-982-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR862034163WC0200X
MS862034363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine