Provider Demographics
NPI:1700419090
Name:THOMAS, AMANDA ASHLEY (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ASHLEY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2227
Mailing Address - Country:US
Mailing Address - Phone:606-670-4474
Mailing Address - Fax:
Practice Address - Street 1:2500 JACKSBORO PIKE STE 6
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2818
Practice Address - Country:US
Practice Address - Phone:423-352-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1158104363LF0000X
TN27163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily