Healthcare Provider Details

I. General information

NPI: 1154674430
Provider Name (Legal Business Name): AMBER T. LOPEZ APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4435 VALLEY VIEW DR STE 102
KNOXVILLE TN
37917
US

IV. Provider business mailing address

5616 DAVIDA RD
KNOXVILLE TN
37912-3820
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-6244
  • Fax:
Mailing address:
  • Phone: 423-314-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17107
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number17107
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: