Provider Demographics
NPI:1720229388
Name:CHRISTOPHER, AMANDA PAIGE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:PAIGE
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:PAIGE
Other - Last Name:TRUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:6060 PRIMACY PKWY
Mailing Address - Street 2:SUITE 241
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5745
Mailing Address - Country:US
Mailing Address - Phone:901-725-5846
Mailing Address - Fax:
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-725-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000144775163WC0200X
TNAPN 14190367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513693Medicaid
MS01873247Medicaid
1720229388OtherCHAMPUS/HUMANA TRICARE
AR183798001Medicaid
TNP00763869OtherRAILROAD MEDICARE
TN4223153OtherBLUE CROSS
TN3604853Medicare PIN