Provider Demographics
NPI:1760521025
Name:MCELYEA, AMANDA ROSE (RN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ROSE
Last Name:MCELYEA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 WHISPERING PINES RD
Mailing Address - Street 2:
Mailing Address - City:UNICOI
Mailing Address - State:TN
Mailing Address - Zip Code:37692-6619
Mailing Address - Country:US
Mailing Address - Phone:423-388-8882
Mailing Address - Fax:
Practice Address - Street 1:415 STATE OF FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6034
Practice Address - Country:US
Practice Address - Phone:423-975-2200
Practice Address - Fax:423-975-2210
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000037117163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health