Healthcare Provider Details

I. General information

NPI: 1346664166
Provider Name (Legal Business Name): AMANDA CARTER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

334 CRESCENT AVE
JACKSON TN
38301-4362
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-4300
  • Fax:
Mailing address:
  • Phone: 731-608-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number17957
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: