Provider Demographics
NPI:1750732582
Name:EAVES, AMANDA LEIGH (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:EAVES
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 S FRONT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4114
Mailing Address - Country:US
Mailing Address - Phone:901-296-3000
Mailing Address - Fax:949-543-2924
Practice Address - Street 1:364 S FRONT ST STE 201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103
Practice Address - Country:US
Practice Address - Phone:901-296-3000
Practice Address - Fax:949-543-2924
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901587363LP0808X
TN21357363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08759340Medicaid
TNQ023617Medicaid