Provider Demographics
NPI:1992558829
Name:EAGAN AKERS, AMY ELIZABETH (EDS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:EAGAN AKERS
Suffix:
Gender:
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 RYAN BOYD CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-5034
Mailing Address - Country:US
Mailing Address - Phone:615-347-4402
Mailing Address - Fax:
Practice Address - Street 1:86 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1323
Practice Address - Country:US
Practice Address - Phone:603-865-9510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000220088103TS0200X
NH145405103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool