Provider Demographics
NPI:1194993345
Name:NEIL, AMY PROVINCE (ANP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:PROVINCE
Last Name:NEIL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:PROVINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-0092
Mailing Address - Country:US
Mailing Address - Phone:865-862-0998
Mailing Address - Fax:865-544-1861
Practice Address - Street 1:7551 DANNAHER LANE
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4026
Practice Address - Country:US
Practice Address - Phone:865-637-9330
Practice Address - Fax:865-512-6748
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13492363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530023Medicaid
TN6051712OtherBCBS
TNP01548991OtherMEDICARE RR
TN6051712OtherBCBS