Active NPI
Amanda Keith
- Licensed Practical Nurse
- Tupelo, MS
National Provider Identifier
1376164459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 324987
- Practice address
- 2434 S Eason Blvd
Tupelo, MS 38804-6942 - Phone
- (662) 640-4595
- Fax
- (662) 680-6416
- NPI assigned
- Apr 30, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 324987 | MS | Primary |
Addresses
Primary practice location
2434 S Eason Blvd
Tupelo, MS 38804-6942
Mailing address
2434 S Eason Blvd
Tupelo, MS 38804-6942
Phone (662) 640-4595
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | amerchant@lifecorehealthgroup.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 324987 | MS | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588204800000",
"number": "1376164459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2434 S EASON BLVD",
"city": "TUPELO",
"state": "MS",
"postal_code": "388046942",
"telephone_number": "662-640-4595",
"fax_number": "662-680-6416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2434 S EASON BLVD",
"city": "TUPELO",
"state": "MS",
"postal_code": "388046942",
"telephone_number": "662-640-4595",
"fax_number": "662-680-6416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEITH",
"first_name": "AMANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-30",
"last_updated": "2020-04-30",
"certification_date": "2020-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MS",
"license": "324987",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "amerchant@lifecorehealthgroup.com",
"affiliation": "N",
"address_1": "2434 S Eason Blvd",
"city": "Tupelo",
"state": "MS",
"country_code": "US",
"postal_code": "388046942",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Tupelo, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.