Provider Demographics
NPI:1871865717
Name:SAVAGE, AMANDA S (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:SAVAGE
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 1:3495 COBBLESTONE BLVD S
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7075
Mailing Address - Country:US
Mailing Address - Phone:662-892-2885
Mailing Address - Fax:662-890-1551
Practice Address - Street 1:3495 COBBLESTONE BLVD S
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7075
Practice Address - Country:US
Practice Address - Phone:662-892-2885
Practice Address - Fax:662-890-1551
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR868540363L00000X
TNAPN0000016413363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner