Healthcare Provider Details

I. General information

NPI: 1134896681
Provider Name (Legal Business Name): AMANDA LEIGH-POLAND YEARY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

512 PENSACOLA RD
KNOXVILLE TN
37923-2724
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-5368
  • Fax:
Mailing address:
  • Phone: 865-659-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number183527
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number30405
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: