Mccullough, Amanda

Mccullough, Amanda is an individual health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Mccullough, Amanda can be contacted via phone (601) 984-6525.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 984-6525
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X R885221 Mississippi

Profile Details

NPI number 1396144549
LBN Legal business name Mccullough, Amanda
Credentials NP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 13th, 2014
Last updated Dec 12th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396144549 NPPES
Mississippi MEDICAID 08873041

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