Healthcare Provider Details

I. General information

NPI: 1184359309
Provider Name (Legal Business Name): AMBER ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2253 CHAMBLISS AVE NW STE 400
CLEVELAND TN
37311-3861
US

IV. Provider business mailing address

2253 CHAMBLISS AVE NW STE 400
CLEVELAND TN
37311-3861
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-5002
  • Fax: 423-476-5969
Mailing address:
  • Phone: 423-476-5002
  • Fax: 423-476-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number210895
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number32017
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: