Provider Demographics
NPI:1649890088
Name:HANNAH, AMANDA L (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:HANNAH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6625 LENOX PARK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-8200
Mailing Address - Country:US
Mailing Address - Phone:901-683-0024
Mailing Address - Fax:901-683-0086
Practice Address - Street 1:6063 MOUNT MORIAH ROAD EXT STE 4
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2665
Practice Address - Country:US
Practice Address - Phone:901-683-0024
Practice Address - Fax:901-683-0086
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN185676163W00000X
TN33968363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse