Healthcare Provider Details

I. General information

NPI: 1255819926
Provider Name (Legal Business Name): AMANDA LYNN BLASSL APRN, FNP-C, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MADISON ST STE 112
MADISON TN
37115-3660
US

IV. Provider business mailing address

223 MADISON ST STE 112
MADISON TN
37115-3660
US

V. Phone/Fax

Practice location:
  • Phone: 406-298-4981
  • Fax: 406-821-7840
Mailing address:
  • Phone:
  • Fax: 406-821-7840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01180214
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN23809
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number337903
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMH12250091
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number287587
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number211979
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: