Basic Information
| Provider Information | |||||||||
| NPI: | 1720558398 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMAYREH | ||||||||
| FirstName: | WAFA | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | KEESLER MEDICAL CENTER | ||||||||
| Address2: | 301 FISHER STREET | ||||||||
| City: | KEESLER AFB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39534 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 FISHER ST | ||||||||
| Address2: | |||||||||
| City: | KEESLER AFB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395342508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2283760385 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2018 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0810006332 | VA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.