Active NPI
Amanda Warden, PA-C
- Medical Physician Assistant
- Fayetteville, TN
National Provider Identifier
1124457650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 89 Cowley Hollow Rd
Fayetteville, TN 37334-6947 - Phone
- (931) 625-3044
- NPI assigned
- Nov 5, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | SC | Primary |
Addresses
Primary practice location
89 Cowley Hollow Rd
Fayetteville, TN 37334-6947
Mailing address
89 Cowley Hollow Rd
Fayetteville, TN 37334-6947
Phone (931) 625-3044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC, NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2045 | SC | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Coverage Services, PC | Past | Accepting new patients |
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Hospitalist Physician
- Monroe, GA
- NPI 1760410385
NC
-
- Hospitalist Physician
- Myrtle Beach, SC
- NPI 1003280108
-
- Nurse Practitioner
- Lawrenceburg, TN
- NPI 1053351593
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383609600000",
"number": "1124457650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "89 COWLEY HOLLOW RD",
"city": "FAYETTEVILLE",
"state": "TN",
"postal_code": "373346947",
"telephone_number": "931-625-3044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "89 COWLEY HOLLOW RD",
"city": "FAYETTEVILLE",
"state": "TN",
"postal_code": "373346947",
"telephone_number": "931-625-3044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WARDEN",
"first_name": "AMANDA",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-11-05",
"last_updated": "2013-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "SC",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.