Provider Demographics
NPI:1902031099
Name:THOMAS, AMANDA HESTER
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:HESTER
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-3815
Mailing Address - Country:US
Mailing Address - Phone:662-205-4058
Mailing Address - Fax:
Practice Address - Street 1:219 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-3815
Practice Address - Country:US
Practice Address - Phone:662-260-4533
Practice Address - Fax:662-260-4576
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR903178363LP0808X
AL1-140387363LP0808X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health