Provider Demographics
NPI:1396427993
Name:AMIS, MADALYN RAE GOLD (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MADALYN
Middle Name:RAE GOLD
Last Name:AMIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MADALYN
Other - Middle Name:RAE
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1090 N ELLINGTON PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2227
Mailing Address - Country:US
Mailing Address - Phone:931-359-0019
Mailing Address - Fax:
Practice Address - Street 1:1090 N ELLINGTON PKWY STE 102
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2227
Practice Address - Country:US
Practice Address - Phone:931-359-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily