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General NPI Number Information
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NPI Number | 1891451936
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Entity Type | Individual
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Provider Name | AMY NICOLE SHORTT ACNP-AG
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Gender | Female
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 271 MEDICAL PARK BLVD
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City | BRISTOL
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State | TN
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Zip | 37620-7455
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Country | US
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Telephone | 423-274-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-952-2111
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Fax | 423-282-1657
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2021040583
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number | 0024190101
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 36565
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0024190101
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License Number State | VA
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