Provider Demographics
NPI:1235831553
Name:WHITE, AMY B (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:WHITE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 INTERSTATE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3191
Mailing Address - Country:US
Mailing Address - Phone:931-728-9000
Mailing Address - Fax:931-728-2726
Practice Address - Street 1:585 INTERSTATE DR STE B
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3191
Practice Address - Country:US
Practice Address - Phone:931-728-9000
Practice Address - Fax:931-728-2726
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN176345163WG0000X
TN33672363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33672OtherAPN LICENSE