Provider Demographics
NPI:1386096279
Name:WILLIAMS, AMANDA LYNN (CNM)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:8446 ANSLEY PARK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7815
Mailing Address - Country:US
Mailing Address - Phone:901-604-5599
Mailing Address - Fax:
Practice Address - Street 1:880 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3409
Practice Address - Country:US
Practice Address - Phone:901-515-3800
Practice Address - Fax:901-302-2491
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS899563367A00000X
TN21605367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife