Provider Demographics
NPI:1790451052
Name:KEY-BURKE, AMANDA ROWENA (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROWENA
Last Name:KEY-BURKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10237 BOSTON LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2092
Mailing Address - Country:US
Mailing Address - Phone:865-316-4505
Mailing Address - Fax:
Practice Address - Street 1:10237 BOSTON LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2092
Practice Address - Country:US
Practice Address - Phone:865-316-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF08210629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily