Provider Demographics
NPI:1538685557
Name:RODGERS, AMANDA MICHELLE (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3128
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37815-3128
Mailing Address - Country:US
Mailing Address - Phone:423-587-1406
Mailing Address - Fax:
Practice Address - Street 1:2021 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-5409
Practice Address - Country:US
Practice Address - Phone:423-587-1406
Practice Address - Fax:423-616-0955
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner