Provider Demographics
NPI:1285943423
Name:RIDNER, AMBER LEA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LEA
Last Name:RIDNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:WIENIEWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:460 MEDICAL PARK DRIVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5782
Mailing Address - Country:US
Mailing Address - Phone:865-562-3232
Mailing Address - Fax:865-317-1115
Practice Address - Street 1:460 MEDICAL PARK DRIVE STE 104
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5782
Practice Address - Country:US
Practice Address - Phone:865-562-3232
Practice Address - Fax:865-317-1115
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN175397163W00000X
TNAPN17403363LF0000X
TNRN0000175397163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533224Medicaid
TN1533224Medicaid