Provider Demographics
NPI:1548675150
Name:ROBERTSON, AMY ROSE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ROSE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ROSE
Other - Last Name:WIDENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 415000-MSC8138
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-8138
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:
Practice Address - Street 1:1130 MIDDLE CREEK RD STE 260
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3055
Practice Address - Country:US
Practice Address - Phone:865-428-7586
Practice Address - Fax:865-428-8671
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN18476363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily