Healthcare Provider Details

I. General information

NPI: 1164199089
Provider Name (Legal Business Name): AMANDA M HOLDER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 OLD HIGHWAY 51 S STE C
BRIGHTON TN
38011-8025
US

IV. Provider business mailing address

1880 OLD HIGHWAY 51 S STE C
BRIGHTON TN
38011-8025
US

V. Phone/Fax

Practice location:
  • Phone: 901-837-7979
  • Fax:
Mailing address:
  • Phone: 901-837-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number219734
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31927
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: