Provider Demographics
NPI:1104941053
Name:BROWN, AMANDA G (FNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:G
Other - Last Name:PARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-0601
Mailing Address - Country:US
Mailing Address - Phone:423-869-3332
Mailing Address - Fax:423-869-3332
Practice Address - Street 1:6976 CUMBERLAND GAP PKWY
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8230
Practice Address - Country:US
Practice Address - Phone:423-869-3332
Practice Address - Fax:423-869-3332
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0380907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP95611Medicare UPIN