Healthcare Provider Details

I. General information

NPI: 1922881713
Provider Name (Legal Business Name): AMANDA SHEA TERWILLIGER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 11/20/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 POPLAR ST
MURRAY KY
42071-2432
US

IV. Provider business mailing address

198 MULLINS LN
BETHEL SPRINGS TN
38315-4465
US

V. Phone/Fax

Practice location:
  • Phone: 270-762-1100
  • Fax:
Mailing address:
  • Phone: 731-439-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4008692
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number231249
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: