Provider Demographics
NPI:1578718342
Name:GLASS, AMY BRADSHAW (ACNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:BRADSHAW
Last Name:GLASS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1904 ALCOA HWY
Mailing Address - Street 2:SUITE 210 E
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920
Mailing Address - Country:US
Mailing Address - Phone:865-524-7471
Mailing Address - Fax:865-305-6563
Practice Address - Street 1:1940 ALCOA HWY
Practice Address - Street 2:SUITE E - 210
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2244
Practice Address - Country:US
Practice Address - Phone:865-524-7471
Practice Address - Fax:865-305-6563
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN150292163W00000X
TN13795363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514111Medicaid
TN1514111Medicaid