Amanda Leigh Edgar, FNP
Individual provider Active NPI Family Nurse Practitioner · Hattiesburg, MS
NPI 1710486808 · NPPES record last updated Jul 28, 2020
Key facts
- NPI
- 1710486808
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 902526 (MS)
- Practice address
- 415 S 28TH Ave
Hattiesburg, MS 39401-7246 - Phone
- (601) 268-5800
- NPI assigned
- Feb 5, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hattiesburg Clinic PA
Practice addresses (Care Compare)
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 264-6000
Hospital & facility affiliations
- Forrest General Home Care
- Mississippi Homecare of Richton
- Forrest General Hospital
- Perry County General Hospital
- Walthall County General Hospital Cah
- Marion General Hospital
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 |
|---|---|---|---|---|
| I20180307002140 | MS | Practitioner - Nurse Practitioner | 8921369968 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 902526 | MS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hattiesburg Clinic PA | Current |
Accepting new patients | |
| Hattiesburg Clinic, PA | Current |
Accepting new patients | |
| Hattiesburg Clinic, PA | Past | Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Past | Accepting new patients |
Locations
415 S 28th Ave
Fl 3
Hattiesburg, MS 39401
Phone (601) 268-1734
415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606
Interoperability endpoints
- abroom70573@directpatientrecord.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 902526 | MS | |
| Family Nurse Practitioner | 363LF0000X | 902526 | MS | Yes |
Addresses
Primary practice location
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Mailing address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 268-5800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03654381 | Medicaid | MS |
Other names
- Amanda Leigh Broom
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | abroom70573@directpatientrecord.com | Health Information Exchange (HIE) |
Other providers in Hattiesburg, MS
- Mary Morgan East
- Kerri Michelle Easterling
- Letoria Easterling
- Quenyatta Echols-Williams
- Economic Stimulus Act Student Loan Refund 1200 Dollars
- Delana Edgar
- Edward Brown Specialty Partners of Mississippi, PLLC
- Edward Robert Cohen
- Ada Catherine Edwards
- Daniel Edwards
All providers in Hattiesburg, MS · Family 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 Jul 28, 2020. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.