Provider Demographics
NPI:1972748895
Name:WHITE, AMY L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 59002
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-9002
Mailing Address - Country:US
Mailing Address - Phone:865-588-5121
Mailing Address - Fax:865-588-5126
Practice Address - Street 1:1311 DOWELL SPRINGS BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2454
Practice Address - Country:US
Practice Address - Phone:865-588-5121
Practice Address - Fax:865-588-5126
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN13856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008668Medicaid
TNQ008668Medicaid