Basic Information
| Provider Information | |||||||||
| NPI: | 1326440199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DREVE | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 210127 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372210127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153832443 | ||||||||
| FaxNumber: | 6153830853 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 22ND AVE N | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153200007 | ||||||||
| FaxNumber: | 6159023983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2014 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 2620 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | Q009554 | 05 | TN | MEDICAID |