Provider Demographics
NPI:1891050548
Name:KUYKENDALL, AMELIA S (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:S
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 S EASON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6549
Mailing Address - Country:US
Mailing Address - Phone:662-377-5265
Mailing Address - Fax:
Practice Address - Street 1:499 GLOSTER CREEK VLG STE G1
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4751
Practice Address - Country:US
Practice Address - Phone:662-377-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR864614163W00000X
MS864614163WR0006X, 363LF0000X
MSF0812323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant