Provider Demographics
NPI:1235390238
Name:BERRY, AMANDA WILSON (CNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:WILSON
Last Name:BERRY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1934 ALCOA HWY
Mailing Address - Street 2:SUITE 476
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1524
Mailing Address - Country:US
Mailing Address - Phone:865-544-9218
Mailing Address - Fax:865-544-8262
Practice Address - Street 1:1934 ALCOA HWY
Practice Address - Street 2:SUITE 476
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1524
Practice Address - Country:US
Practice Address - Phone:865-544-9218
Practice Address - Fax:865-544-8262
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily