Provider Demographics
NPI:1538645759
Name:AMANDA EAVES, PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER, LLC
Entity Type:Organization
Organization Name:AMANDA EAVES, PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER, LLC
Other - Org Name:DOWNTOWN PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:901-296-3000
Mailing Address - Street 1:PO BOX 3145
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38173-0145
Mailing Address - Country:US
Mailing Address - Phone:901-296-3000
Mailing Address - Fax:
Practice Address - Street 1:364 S FRONT ST STE 201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4114
Practice Address - Country:US
Practice Address - Phone:901-296-3000
Practice Address - Fax:949-543-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21357363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty