Amanda Mackillop, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

403484 Issued in NY

Practice address

54655 Main Rd
Southold, NY 11971-4769

Phone

(631) 301-2271

Fax

(631) 212-0482

NPI assigned

Nov 13, 2019

Last updated

Dec 17, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Meeting House Lane Medical Practice PCGroup PAC ID 6800972589, 125 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: amanda.mackillop.p1@direct.shproviders.nextgenshare.com

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

• Meeting House Lane Medical Practice PC

  • Internal Medicine Physician
  • Southampton, NY
  • NPI 1902088495

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Dr. Christina Vaglica Psychiatry, P.C.

  • Psychiatry Physician
  • Bay Shore, NY
  • NPI 1255900320

  Single Specialty

  NPD
• Dr. Christina Vaglica Psychiatry, P.C.

  • Psychiatry Physician
  • Bay Shore, NY
  • NPI 1881482305

  Single Specialty

  NPD

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1770128753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54655 MAIN RD",
            "city": "SOUTHOLD",
            "state": "NY",
            "postal_code": "119714769",
            "telephone_number": "631-301-2271",
            "fax_number": "631-212-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54655 MAIN RD",
            "city": "SOUTHOLD",
            "state": "NY",
            "postal_code": "119714769",
            "telephone_number": "631-301-2271",
            "fax_number": "631-212-0482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKILLOP",
        "first_name": "AMANDA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-13",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403484",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "780342",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert T Kroepel, DDS
• Kathryn Krukowski
• William Lappe, LPN
• Lisa C. Deluca, LCSW, PLLC
• Long Island Podiatry PC
• Mako Residence
• Janet Elaine Marin, PT
• Amy McGrath, SLP CCC
• Katherine Elizabeth Meehan, PSY.D
• Olha Michalak

• Psychiatric/Mental Health Nurse Practitioner in Southold, NY
• Providers in Southold, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.