MEDICARE: MRS. AMANDA LYNN MITCHELL RN

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	163WC1500X	Community Health Registered Nurse	160044	TN

General Provider Information

NPI Number	:	1730415803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LYNN MITCHELL RN

Provider Business Mailing Address
First Line	:	5457 OAK GROVE RD
Second Line	:
City	:	RED BOILING SPRINGS
State	:	TN
Zip	:	37150-3743
Country	:	US
Telephone Number	:	931-261-5642
Fax Number	:

Provider Business Practice Location Address
First Line	:	5457 OAK GROVE RD
Second Line	:
City	:	RED BOILING SPRINGS
State	:	TN
Zip	:	37150-3743
Country	:	US
Telephone Number	:	931-261-5642
Fax Number	:

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

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	10/26/2009

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