Provider Demographics
NPI:1811750755
Name:BLACK, AMY LYNN (PMHNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BLACK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 HOMBERG DR STE 22A
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5029
Mailing Address - Country:US
Mailing Address - Phone:865-269-9452
Mailing Address - Fax:865-409-5889
Practice Address - Street 1:5410 HOMBERG DR STE 22A
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5029
Practice Address - Country:US
Practice Address - Phone:865-269-9452
Practice Address - Fax:865-409-5889
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35198363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health