Individual provider Active NPI

Amanda Smith, FNP-C

  • Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1235940842
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
906736 Issued in MS
Practice address
4250 S Eason Blvd
Tupelo, MS 38801-6549
Phone
(662) 377-5265
NPI assigned
Jan 15, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 906736 MS Primary

Addresses

Primary practice location

4250 S Eason Blvd
Tupelo, MS 38801-6549

Mailing address

285 County Road 166
Houston, MS 38851-9271

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250211000026 MS Practitioner - Nurse Practitioner 1052841715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4250 S Eason Blvd
Ortho Trauma Services Clinic
Tupelo, MS 38801-6549
Phone (662) 377-5265

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center Services LLC CurrentSince Jan 23, 2025 Accepting new patients
North Mississippi Medical Center Current Accepting new patients
North Mississippi Medical Center Services LLC CurrentSince Jan 23, 2025 Accepting new patients

Locations

808 Varsity Dr
Tupelo, MS 38801
Phone (662) 377-2386

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

4250 S Eason Blvd
Tupelo, MS 38801
Phone (662) 377-5265

Interoperability endpoints

  • Direct secure messaging: amandasmith@nmhs.medalliesdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1235940842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 COUNTY ROAD 166",
            "city": "HOUSTON",
            "state": "MS",
            "postal_code": "388519271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 S EASON BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016549",
            "telephone_number": "662-377-5265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AMANDA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-15",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "906736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.