Provider Demographics
NPI:1013306596
Name:FREDERICK, AMANDA (MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:209 GOTHIC CT STE 108
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2812
Mailing Address - Country:US
Mailing Address - Phone:615-909-5985
Mailing Address - Fax:
Practice Address - Street 1:209 GOTHIC CT STE 108
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2812
Practice Address - Country:US
Practice Address - Phone:615-909-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007031264363LF0000X
TN32210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily