Provider Demographics
NPI:1720229388
Name:CHRISTOPHER, AMANDA PAIGE (CRNA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:PAIGE
Last Name:CHRISTOPHER
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:PAIGE
Other - Last Name:TRUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:6060 PRIMACY PKWY
Mailing Address - Street 2:SUITE 241
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5745
Mailing Address - Country:US
Mailing Address - Phone:901-725-5846
Mailing Address - Fax:
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-725-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 14190367500000X
MS901583367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01873247Medicaid
TN4223153OtherBLUE CROSS
AR183798001Medicaid
TN1513693Medicaid
TNP00763869OtherRAILROAD MEDICARE
TN4223153OtherBLUE CROSS
TN3604853Medicare PIN