Provider Demographics
NPI:1972042653
Name:HARKNESS, AMY W (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:W
Last Name:HARKNESS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 CORDES RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-4421
Mailing Address - Country:US
Mailing Address - Phone:901-603-3310
Mailing Address - Fax:
Practice Address - Street 1:6401 POPLAR AVE STE 220
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4884
Practice Address - Country:US
Practice Address - Phone:901-603-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00486542Medicaid
TNQ02914Medicaid