Individual
AMANDA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
472 W POPLAR AVE, 101, COLLIERVILLE, TN 38017-2538
(901) 854-5771
Mailing address
PO BOX 381071, GERMANTOWN, TN 38183-1071
(901) 754-5633
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
A810519
MS
363LF0000X
Family Nurse Practitioner
Primary
APN0000017457
TN
Other
Enumeration date
06/28/2013
Last updated
08/08/2014
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