Provider Demographics
NPI:1932568797
Name:PROFFITT, AMANDI NICHOLE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDI
Middle Name:NICHOLE
Last Name:PROFFITT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 INTERSTATE DR
Mailing Address - Street 2:STE 103
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-2704
Mailing Address - Country:US
Mailing Address - Phone:931-210-5577
Mailing Address - Fax:931-210-5575
Practice Address - Street 1:417 E EMORY RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3518
Practice Address - Country:US
Practice Address - Phone:865-938-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1932568797363LF0000X
TNAPN0000020460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily