Healthcare Provider Details

I. General information

NPI: 1497107874
Provider Name (Legal Business Name): AMY E GREER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 S HIGHLAND AVE
JACKSON TN
38301-7741
US

IV. Provider business mailing address

40 GOODEN CV
JACKSON TN
38305-9487
US

V. Phone/Fax

Practice location:
  • Phone: 731-499-8708
  • Fax: 731-499-8709
Mailing address:
  • Phone: 173-166-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21276
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN0000021276
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: