Provider Demographics
NPI:1316460090
Name:LOTT, AMY MALINDA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MALINDA
Last Name:LOTT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:719 WOODRUN DR
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-7913
Mailing Address - Country:US
Mailing Address - Phone:601-946-4805
Mailing Address - Fax:
Practice Address - Street 1:1616 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451-5622
Practice Address - Country:US
Practice Address - Phone:601-394-2381
Practice Address - Fax:601-394-2593
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902191363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology