Provider Demographics
NPI:1801524293
Name:WARD, AMANDA DEANN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DEANN
Last Name:WARD
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 1:595 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653-9233
Mailing Address - Country:US
Mailing Address - Phone:601-384-3199
Mailing Address - Fax:601-384-3950
Practice Address - Street 1:595 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653-9233
Practice Address - Country:US
Practice Address - Phone:601-384-3199
Practice Address - Fax:601-384-3950
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health