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NPI Code Detail

MEDICARE: AMY L DEVORE CNM

MEDICARE: AMY L DEVORE CNM
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
1367A00000XAdvanced Practice Midwife8124TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2300917OTHERVAANTHEM CROSSOVER PN

General Provider Information

NPI Number : 1073523882
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY L DEVORE CNM
Provider Business Mailing Address
First Line : 877 JEFFERSON AVE
Second Line : ATTN: PROVIDER ENROLLMENT
City : MEMPHIS
State : TN
Zip : 38103-2807
Country : US
Telephone Number : 901-545-8336
Fax Number : 901-545-8122
Provider Business Practice Location Address
First Line : 2500 PERES AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38108-1660
Country : US
Telephone Number : 901-515-5500
Fax Number : 901-458-5591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 08/13/2014

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