Individual
AMANDA R. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
111 W STONE DR STE 110, KINGSPORT, TN 37660-6027
(423) 224-3701
(423) 224-3709
Mailing address
1101 E STONE DR, SUITE 2, KINGSPORT, TN 37660-3384
(423) 224-1110
(423) 224-1130
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
182185
TN
363LF0000X
Family Nurse Practitioner
Primary
19521
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447658919
—
VA
05
—
Q010785
—
TN
Enumeration date
12/15/2014
Last updated
06/06/2018
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