Provider Demographics
NPI:1679667000
Name:AUSTIN, AMANDA YVETTE (FNP, APRN-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:YVETTE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:FNP, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 W BADDOUR PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2513
Mailing Address - Country:US
Mailing Address - Phone:615-444-1118
Mailing Address - Fax:615-443-0465
Practice Address - Street 1:669 S. MT. JULIET RD.
Practice Address - Street 2:
Practice Address - City:MT. JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6483
Practice Address - Country:US
Practice Address - Phone:615-758-2929
Practice Address - Fax:615-758-2919
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN11642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ64753Medicare UPIN
TN3642568Medicare ID - Type Unspecified