Healthcare Provider Details

I. General information

NPI: 1801261607
Provider Name (Legal Business Name): AMANDA CUDNEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 MAIN ST
NASHVILLE TN
37206-3614
US

IV. Provider business mailing address

135 REESE RUN CT
MONTGOMERY TX
77316-2122
US

V. Phone/Fax

Practice location:
  • Phone: 615-436-9060
  • Fax: 615-235-9725
Mailing address:
  • Phone: 832-606-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: