Healthcare Provider Details

I. General information

NPI: 1073919619
Provider Name (Legal Business Name): AMANDA YOUNG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA WALKER CRNA

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 22ND AVE N STE 300
NASHVILLE TN
37203-0802
US

IV. Provider business mailing address

110 29TH AVE N SUITE 301
NASHVILLE TN
37203-1401
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-2320
  • Fax:
Mailing address:
  • Phone: 615-327-4304
  • Fax: 615-327-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number19411
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: