Healthcare Provider Details

I. General information

NPI: 1831676840
Provider Name (Legal Business Name): AMANDA DEASON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 HIGHWAY 13 S
WAVERLY TN
37185-2109
US

IV. Provider business mailing address

451 HIGHWAY 13 S
WAVERLY TN
37185-2109
US

V. Phone/Fax

Practice location:
  • Phone: 931-296-0211
  • Fax:
Mailing address:
  • Phone: 931-296-0211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24464
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: