Healthcare Provider Details

I. General information

NPI: 1649890088
Provider Name (Legal Business Name): AMANDA L HANNAH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6063 MOUNT MORIAH ROAD EXT STE 4
MEMPHIS TN
38115-2665
US

IV. Provider business mailing address

6625 LENOX PARK DR STE 202
MEMPHIS TN
38115-8200
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0024
  • Fax: 901-683-0086
Mailing address:
  • Phone: 901-683-0024
  • Fax: 901-683-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number33968
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: