Provider Demographics
NPI:1396292033
Name:NASON, AMANDA D (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:NASON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:145 SYCAMORE RDG
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7333
Mailing Address - Country:US
Mailing Address - Phone:601-757-0582
Mailing Address - Fax:
Practice Address - Street 1:3531 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8049
Practice Address - Country:US
Practice Address - Phone:601-936-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901668363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health