MEDICARE: AMANDA YVETTE AUSTIN FNP, APRN-BC

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	11642	TN

General Provider Information

NPI Number	:	1679667000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA YVETTE AUSTIN FNP, APRN-BC

Provider Business Mailing Address
First Line	:	1425 W BADDOUR PKWY
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2513
Country	:	US
Telephone Number	:	615-444-1118
Fax Number	:	615-443-0465

Provider Business Practice Location Address
First Line	:	669 S. MT. JULIET RD.
Second Line	:
City	:	MT. JULIET
State	:	TN
Zip	:	37122-6483
Country	:	US
Telephone Number	:	615-758-2929
Fax Number	:	615-758-2919

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/29/2010

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