Individual
MRS. COREY AMANDA PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
621 OLD HICKORY BLVD, SUITE G, JACKSON, TN 38305-2907
(731) 660-6402
(731) 664-6603
Mailing address
621 OLD HICKORY BOULEVARD, SUITE G, JACKSON, TN 38305
(731) 660-6402
(731) 664-6603
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
160987
TN
363LF0000X
Family Nurse Practitioner
Primary
15639
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12249160
CAQH
TN
Enumeration date
02/17/2011
Last updated
10/24/2013
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