Provider Demographics
NPI:1760670392
Name:ERMIS, AMANDA BLOUNT (FNP, AGACNP, DNP)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BLOUNT
Last Name:ERMIS
Suffix:
Gender:F
Credentials:FNP, AGACNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BIG HARPE TRAIL
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866
Mailing Address - Country:US
Mailing Address - Phone:901-310-7945
Mailing Address - Fax:
Practice Address - Street 1:110 BIG HARPE TRAIL
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866
Practice Address - Country:US
Practice Address - Phone:901-545-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011114363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3642247Medicare PIN
TNQ61652Medicare UPIN