Provider Demographics
NPI:1013476738
Name:FOUTS, AMY (DNP, BSN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FOUTS
Suffix:
Gender:F
Credentials:DNP, BSN, AGACNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:HEAFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6031 SHALLOWFORD RD STE 117
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1984
Mailing Address - Country:US
Mailing Address - Phone:423-498-3570
Mailing Address - Fax:423-498-3571
Practice Address - Street 1:6031 SHALLOWFORD RD STE 117
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1984
Practice Address - Country:US
Practice Address - Phone:423-498-3570
Practice Address - Fax:423-498-3571
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223165363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology