Healthcare Provider Details

I. General information

NPI: 1396896601
Provider Name (Legal Business Name): AMY C MULLIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 MCCALLIE AVE SUITE 309
CHATTANOOGA TN
37404-3256
US

IV. Provider business mailing address

2339 MCCALLIE AVE SUITE 309
CHATTANOOGA TN
37404-3256
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-0850
  • Fax: 423-698-0511
Mailing address:
  • Phone: 423-698-0850
  • Fax: 423-698-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN0000012399
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: