MEDICARE: MRS. AMY DOYLE SULLIVAN 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	163WE0003X	Emergency Registered Nurse	211737	TN
2	363LF0000X	Family Nurse Practitioner	35913	TN

General Provider Information

NPI Number	:	1447033360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY DOYLE SULLIVAN FNP

Provider Business Mailing Address
First Line	:	2004 HIGHWAY 47 N
Second Line	:
City	:	WHITE BLUFF
State	:	TN
Zip	:	37187-4100
Country	:	US
Telephone Number	:	615-908-3680
Fax Number	:	615-908-3679

Provider Business Practice Location Address
First Line	:	2004 HIGHWAY 47 N
Second Line	:
City	:	WHITE BLUFF
State	:	TN
Zip	:	37187-4100
Country	:	US
Telephone Number	:	615-908-3680
Fax Number	:	615-908-3679

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

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	01/08/2025

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