Provider Demographics
NPI:1730369612
Name:TOWNSEND, AMANDA ALISA (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ALISA
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 DIVISION STREET SUITE C
Mailing Address - Street 2:MEDICAL ANALYSIS
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-2969
Mailing Address - Country:US
Mailing Address - Phone:228-388-2599
Mailing Address - Fax:
Practice Address - Street 1:1025 DIVISION STREET SUITE C
Practice Address - Street 2:MEDICAL ANALYSIS
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2969
Practice Address - Country:US
Practice Address - Phone:228-388-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139768163WS0200X
OH405107-COA1163WS0200X
MSR886153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1730369612Medicare UPIN