Individual provider Active NPI

Amanda Lynn Gay, SLP

  • Speech-Language Pathologist
  • Hattiesburg, MS
National Provider Identifier
1831491687
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
S2814 Issued in MS
Practice address
102 Medical Park
Hattiesburg, MS 39401-9080
Phone
(601) 261-5159
Fax
(601) 579-5240
NPI assigned
Nov 30, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X S2814 MS Primary

Addresses

Primary practice location

102 Medical Park
Hattiesburg, MS 39401-9080

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 261-5159

Other practice location 1

4109 Highway 98 W
Summit, MS 39666-9132
Phone (601) 276-3900

Other identifiers 1

IdentifierTypeStateIssuer
03689700MedicaidMS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address agay113131@directpatientrecord.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210609002857 MS Practitioner - Qualified Speech Language Pathologist 7315347523 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S2814MSMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic PA CurrentSince May 25, 2021 Accepting new patients
Hattiesburg Clinic, PA CurrentSince May 25, 2021 Accepting new patients
Hattiesburg Clinic PA CurrentSince Jun 3, 2025 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
Hattiesburg, MS 39401
Phone (601) 261-3606

102 Medical Park
Ste B
Hattiesburg, MS 39401
Phone (601) 261-1650

102 Medical Park
Hattiesburg, MS 39401
Phone (601) 261-1650

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1831491687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-261-5159",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 MEDICAL PARK",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394019080",
            "telephone_number": "601-261-5159",
            "fax_number": "601-579-5240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4109 Highway 98 W",
            "address_purpose": "LOCATION",
            "city": "Summit",
            "state": "MS",
            "postal_code": "396669132",
            "country_code": "US",
            "telephone_number": "601-276-3900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAY",
        "first_name": "AMANDA",
        "middle_name": "LYNN",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-30",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S2814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03689700",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agay113131@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "102 Medical Park",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394019080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.