MEDICARE: MRS. AMANDA FREDERICK MSN, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2007031264	MO
2	363LF0000X	Family Nurse Practitioner	32210	TN

General Provider Information

NPI Number	:	1013306596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA FREDERICK MSN, FNP

Provider Business Mailing Address
First Line	:	209 GOTHIC CT STE 108
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2812
Country	:	US
Telephone Number	:	615-909-5985
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 GOTHIC CT STE 108
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2812
Country	:	US
Telephone Number	:	615-909-5985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	01/03/2024

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