Provider Demographics
NPI:1598746372
Name:MYERS, AMY MICHELLE (CFNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:MYERS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W HARPER ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:TN
Mailing Address - Zip Code:38260-5633
Mailing Address - Country:US
Mailing Address - Phone:731-592-0717
Mailing Address - Fax:
Practice Address - Street 1:1109 E REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5856
Practice Address - Country:US
Practice Address - Phone:731-884-0600
Practice Address - Fax:731-885-6171
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10997363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3640313Medicaid
TN3640313Medicare ID - Type Unspecified
TN3640313Medicaid