Provider Demographics
NPI:1932681178
Name:TURNER, AMANDA BROOKE (APN)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BROOKE
Last Name:TURNER
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 1:3771 W SHAWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:TN
Mailing Address - Zip Code:38260-4047
Mailing Address - Country:US
Mailing Address - Phone:731-796-0194
Mailing Address - Fax:
Practice Address - Street 1:1109 E REELFOOT AVE STE D
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5866
Practice Address - Country:US
Practice Address - Phone:731-599-9909
Practice Address - Fax:731-599-9970
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ074944Medicaid