Provider Demographics
NPI:1467482802
Name:DECKER, AMANDA S (FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:DECKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2855
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:1020 HIGHWAY 47 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2540
Practice Address - Country:US
Practice Address - Phone:615-441-4499
Practice Address - Fax:615-441-4493
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN11767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4164611OtherBCBS OF TN
TN4164612OtherBCBS OF TN
KY7100013400Medicaid
TN36441711Medicaid
TN36441711Medicaid
KY7100013400Medicaid