Provider Demographics
NPI:1831453091
Name:SHOULDERS THOMAS, AMY MONETT-SHAMON (FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MONETT-SHAMON
Last Name:SHOULDERS THOMAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:MONET-SHAMON
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:115 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MS
Mailing Address - Zip Code:39041-3209
Mailing Address - Country:US
Mailing Address - Phone:601-866-7723
Mailing Address - Fax:601-866-7773
Practice Address - Street 1:115 W MADISON ST
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MS
Practice Address - Zip Code:39041-3209
Practice Address - Country:US
Practice Address - Phone:601-866-7723
Practice Address - Fax:601-866-7773
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2021-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF0312107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily