Individual provider Active NPI

Amanda Michelle Oliver

  • Family Nurse Practitioner
  • Kingsport, TN
National Provider Identifier
1720542376
Registry record updated Jan 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
25408 Issued in TN
Practice address
404 Manor Dr Apt F
Kingsport, TN 37660-3471
Phone
(423) 914-3963
NPI assigned
Jan 29, 2019
Last updated
Jan 29, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 25408 TN Primary

Addresses

Primary practice location

404 Manor Dr Apt F
Kingsport, TN 37660-3471

Mailing address

404 Manor Dr Apt F
Kingsport, TN 37660-3471
Phone (423) 914-3963

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191025000235 TN Practitioner - Nurse Practitioner 6800128778 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-Cities Regional Emergency Physicians, PCGroup PAC ID 3678859477, 118 clinicians

Practice addresses (Care Compare)

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-4000

Merit-based Incentive Payment System (MIPS)

Final score
90.33 of 100Reported as group
Quality
83.8
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
25408TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
App of Tennessee Ed, PLLC CurrentSince Oct 1, 2019 Accepting new patients
Tri-Cities Regional Emergency Physicians, PC CurrentSince Jun 25, 2021 Accepting new patients

Locations

5121 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 436-6556

106 Medical Center Blvd
Fayetteville, TN 37334
Phone (931) 438-1100

400 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-1310

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

907 Lamar Alexander Pkwy
Maryville, TN 37804
Phone (865) 766-8818

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1720542376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 MANOR DR APT F",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603471",
            "telephone_number": "423-914-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 MANOR DR APT F",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603471",
            "telephone_number": "423-914-3963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "AMANDA",
        "middle_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "25408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.