Healthcare Provider Details

I. General information

NPI: 1629413414
Provider Name (Legal Business Name): AMANDA KAYE MAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N MAIN ST
CLINTON TN
37716-3143
US

IV. Provider business mailing address

710 N MAIN ST
CLINTON TN
37716-3143
US

V. Phone/Fax

Practice location:
  • Phone: 865-425-8800
  • Fax:
Mailing address:
  • Phone: 865-425-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000136949
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: