Healthcare Provider Details

I. General information

NPI: 1720307978
Provider Name (Legal Business Name): AMITY JILL MALLOY MSN, APN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMITY JILL MOORE

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 SHALLOWFORD RD STE 100
CHATTANOOGA TN
37421-1663
US

IV. Provider business mailing address

6141 SHALLOWFORD RD STE 100
CHATTANOOGA TN
37421-1663
US

V. Phone/Fax

Practice location:
  • Phone: 423-498-2000
  • Fax: 423-498-2001
Mailing address:
  • Phone: 423-498-2000
  • Fax: 423-498-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number14962
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14962
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: