Healthcare Provider Details

I. General information

NPI: 1740917848
Provider Name (Legal Business Name): AMY OWENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 BONNIE LN STE 105
CORDOVA TN
38016-0519
US

IV. Provider business mailing address

5370 WATKINS GLEN CIR E APT 206
ARLINGTON TN
38002-4974
US

V. Phone/Fax

Practice location:
  • Phone: 901-620-9480
  • Fax:
Mailing address:
  • Phone: 901-620-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number167096
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32344
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: