Provider Demographics
NPI:1710288675
Name:SLOAN, AMY ELIZABETH (APN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:SLOAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:DEPT 07-075
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-1798
Mailing Address - Country:US
Mailing Address - Phone:731-410-6777
Mailing Address - Fax:731-410-6778
Practice Address - Street 1:111 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2040
Practice Address - Country:US
Practice Address - Phone:731-410-6777
Practice Address - Fax:731-410-6778
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15344363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health