Provider Demographics
NPI:1033970116
Name:MEJIA, AMBER ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ELAINE
Last Name:MEJIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:ELAINE
Other - Last Name:MAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:179 QUAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-7415
Mailing Address - Country:US
Mailing Address - Phone:870-623-8410
Mailing Address - Fax:
Practice Address - Street 1:179 QUAIL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-7415
Practice Address - Country:US
Practice Address - Phone:870-623-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily