Individual
MS. AMANDA JO COULTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
3128 FAIROAKS DR, MARYVILLE, TN 37803-7308
(865) 386-4595
Mailing address
3128 FAIROAKS DR, MARYVILLE, TN 37803-7308
(865) 386-4595
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
28503
TN
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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