MEDICARE: MS. REVREY AMEY NURSE PRACTITIONER

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	RN0000124219	TN
2	363LF0000X	Family Nurse Practitioner	APN21448	TN

General Provider Information

NPI Number	:	1265984876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REVREY AMEY NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2516 PULASKI HWY
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-5753
Country	:	US
Telephone Number	:	931-548-2656
Fax Number	:	931-223-8888

Provider Business Practice Location Address
First Line	:	2516 PULASKI HWY
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-5753
Country	:	US
Telephone Number	:	931-548-2656
Fax Number	:	931-223-8888

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

Provider Enumeration Date	:	10/30/2016
Last Update Date	:	05/04/2022

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