Healthcare Provider Details

I. General information

NPI: 1669376299
Provider Name (Legal Business Name): AMANDA KENNEDY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 WOLF PARK DR
GERMANTOWN TN
38138-1741
US

IV. Provider business mailing address

7063 OAK ACRES LN
BARTLETT TN
38135-1878
US

V. Phone/Fax

Practice location:
  • Phone: 901-755-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number41089
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: