Provider Demographics
NPI:1316644990
Name:DAVIS, AMANDA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 PEOPLES ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4157
Mailing Address - Country:US
Mailing Address - Phone:423-631-0101
Mailing Address - Fax:
Practice Address - Street 1:2800 PEOPLES ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4157
Practice Address - Country:US
Practice Address - Phone:423-631-0101
Practice Address - Fax:423-328-9027
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000030767363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner