Basic Information
| Provider Information | |||||||||
| NPI: | 1710430533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYATT | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | RRT, RPSGT, CCSH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 RIVER OAKS DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013262599 | ||||||||
| FaxNumber: | 6019330852 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 RIVER OAKS DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392329530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013262599 | ||||||||
| FaxNumber: | 6019330852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2016 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225500000X | 8822 | MS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | 225500000X | 018 | MS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | 225500000X | 805 | MS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | 227800000X | RCP1394 | MS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | 227900000X | RCP1394 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.