=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063769719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA MICHELE MULLINS NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2012
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 712 PROFESSIONAL PLAZA DR
-----------------------------------------------------
City | GREENEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37745-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-820-0432
-----------------------------------------------------
Fax | 423-525-8795
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 712 PROFESSIONAL PLAZA DR
-----------------------------------------------------
City | GREENEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37745-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-820-0432
-----------------------------------------------------
Fax | 423-525-8795
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0024170245
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 32642
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------