Provider Demographics
NPI:1013410380
Name:ENDSLEY, MARY AMANDA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:AMANDA
Last Name:ENDSLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:AMANDA
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1970 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8240
Mailing Address - Country:US
Mailing Address - Phone:931-455-3399
Mailing Address - Fax:
Practice Address - Street 1:491 MAJORS BLVD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:TN
Practice Address - Zip Code:37352-8344
Practice Address - Country:US
Practice Address - Phone:931-759-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000023958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily