Healthcare Provider Details

I. General information

NPI: 1881038461
Provider Name (Legal Business Name): AMY NANETTE BUCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 CLINCH AVE STE 110
KNOXVILLE TN
37916-2435
US

IV. Provider business mailing address

1819 CLINCH AVE STE 110
KNOXVILLE TN
37916-2435
US

V. Phone/Fax

Practice location:
  • Phone: 865-331-9075
  • Fax: 865-374-2141
Mailing address:
  • Phone: 865-331-9075
  • Fax: 865-374-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17590
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: