Amanda Chappell, NP – Primary Care Nurse Practitioner

Key facts

NPI: 1083281174
Entity type: Individual (NPI type 1)
Primary specialty: Primary Care Nurse Practitioner 363LP2300X
License: 904670 (MS)
Practice address: 201 Highway 51 N Ste a
Brookhaven, MS 39601-2653
Phone: (601) 515-4949
NPI assigned: Jun 7, 2021
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Community Care Health Network LLC Nurse Practitioner · Nashville, TN · NPI 1619368842

Medicare reassignment NPD MS

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MS
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20210727000905	MS	Practitioner - Nurse Practitioner	5991108037	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

State licenses

License	State	Type	Specialty
904670	MS	MD	Primary Care Nurse Practitioner

Practice roles

Organization	Specialty	Status	New patients
Community Care Health Network LLC		Current since Dec 1, 2023	Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

232 Market St
Jackson, MS 39232
Phone (588) 498-6767

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Primary Care Clinic/Center	261QP2300X		MS
Primary Care Clinic/Center	261QP2300X
Primary Care Nurse Practitioner	363LP2300X	904670	MS	Yes

Addresses

Primary practice location

201 Highway 51 N Ste a
Brookhaven, MS 39601-2653

Mailing address

322 Noble Dr
Brookhaven, MS 39601-3628
Phone (601) 316-0600

Other providers in Brookhaven, MS

William Graham Carter, FNP-C
Amy Katheryn Case, FNP, ADM
Kimberly Case
Meghan Lynn Case, MD
Ryan Corey Case, MD
Robert Dean Chappell Jr., FNP-C
Paige V Chisolm, NP
Chloe'S Caring Hands Healthcare LLC
Jeffrey G Clark, M.D.
Candice Nicole Cliburn, NURSE PRACTITIONER

All providers in Brookhaven, MS · Primary Care Nurse Practitioner in Mississippi

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.