Provider Demographics
NPI:1972349942
Name:NELSON, AMANDA (MSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 SANDTRAIL
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-5434
Mailing Address - Country:US
Mailing Address - Phone:601-744-6136
Mailing Address - Fax:
Practice Address - Street 1:688 ANTELOPE GAP RD
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-8810
Practice Address - Country:US
Practice Address - Phone:307-331-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical