Provider Demographics
NPI:1649598343
Name:AMANDA S. FERGUSON FNP INC
Entity Type:Organization
Organization Name:AMANDA S. FERGUSON FNP INC
Other - Org Name:AMANDA S. RAYMOND FNP INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:865-882-2002
Mailing Address - Street 1:2415 N GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8609
Mailing Address - Country:US
Mailing Address - Phone:865-882-2002
Mailing Address - Fax:
Practice Address - Street 1:2415 N GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8609
Practice Address - Country:US
Practice Address - Phone:865-882-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty