Provider Demographics
NPI:1316283302
Name:COOK, AMANDA MANLEY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MANLEY
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3845
Mailing Address - Country:US
Mailing Address - Phone:615-604-0577
Mailing Address - Fax:615-453-2856
Practice Address - Street 1:507 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3845
Practice Address - Country:US
Practice Address - Phone:615-604-0577
Practice Address - Fax:615-453-2856
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000017164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily