Healthcare Provider Details

I. General information

NPI: 1750732582
Provider Name (Legal Business Name): AMANDA LEIGH EAVES APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 S FRONT ST STE 201
MEMPHIS TN
38103
US

IV. Provider business mailing address

364 S FRONT ST STE 201
MEMPHIS TN
38103-4114
US

V. Phone/Fax

Practice location:
  • Phone: 901-296-3000
  • Fax: 949-543-2924
Mailing address:
  • Phone: 901-296-3000
  • Fax: 949-543-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number901587
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number21357
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: