Provider Demographics
NPI:1457134686
Name:RANSON, AMANDA GRUBBS (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRUBBS
Last Name:RANSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HUMPHREYS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2374
Mailing Address - Country:US
Mailing Address - Phone:901-747-0040
Mailing Address - Fax:
Practice Address - Street 1:55 HUMPHREYS CENTER DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2374
Practice Address - Country:US
Practice Address - Phone:901-747-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34371363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner