Basic Information
| Provider Information | |||||||||
| NPI: | 1184284374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLOOD | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5683 S REX RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381193821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013500678 | ||||||||
| FaxNumber: | 9013500677 | ||||||||
| Practice Location | |||||||||
| Address1: | 176 BRIARWOOD ST STE B | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383201456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312132720 | ||||||||
| FaxNumber: | 9013503677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2019 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 25974 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.