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General NPI Number Information
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NPI Number | 1467269035
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Entity Type | Individual
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Provider Name | AMANDA GRIZZLE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 2971 FORT HENRY DR
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City | KINGSPORT
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State | TN
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Zip | 37664-4005
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Country | US
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Telephone | 423-416-3823
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Fax |
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Provider Business Mailing Address
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Address Line | 439 OVERVIEW LOOP
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City | JONESVILLE
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State | VA
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Zip | 24263-7929
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Country | US
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Telephone | 276-219-5323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 37650
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License Number State | TN
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