Amber Provenzano

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN196795 Issued in GA

Practice address

6734 Lee Hwy
Chattanooga, TN 37421-2423

Phone

(423) 899-0431

Fax

(423) 499-9552

NPI assigned

Feb 26, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Chattanooga Allergy Clinic , PLLCGroup PAC ID 6507879962, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Chattanooga Allergy Clinic , PLLC

  • Allergy & Immunology Physician
  • Chattanooga, TN
  • NPI 1770594129

  GA

  Medicare reassignment Care Compare group
• Tennessee Kidney Care PLLC

  • Nephrology Physician
  • Cleveland, TN
  • NPI 1073963716
  NPD (past)

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

{
    "created_epoch": "1424908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587600000000",
    "number": "1780076752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6734 LEE HWY",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212423",
            "telephone_number": "423-899-0431",
            "fax_number": "423-499-9552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6734 LEE HWY",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374212423",
            "telephone_number": "423-899-0431",
            "fax_number": "423-499-9552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3760 Ocoee Pl NW Ste 100",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "TN",
            "postal_code": "373125637",
            "country_code": "US",
            "telephone_number": "423-899-0431",
            "fax_number": "423-499-9552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1506 N Thornton Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Dalton",
            "state": "GA",
            "postal_code": "307208515",
            "country_code": "US",
            "telephone_number": "423-899-0431",
            "fax_number": "423-499-9552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "163 Walnut Grove Church Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "TN",
            "postal_code": "373216105",
            "country_code": "US",
            "telephone_number": "423-899-0431",
            "fax_number": "423-499-9552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4630 Battlefield Pkwy",
            "address_purpose": "LOCATION",
            "city": "Ringgold",
            "state": "GA",
            "postal_code": "307368004",
            "country_code": "US",
            "telephone_number": "423-899-0431",
            "fax_number": "423-499-9552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24 Mountain View Dr",
            "address_purpose": "LOCATION",
            "city": "Kimball",
            "state": "TN",
            "postal_code": "373475477",
            "country_code": "US",
            "telephone_number": "423-899-0431",
            "fax_number": "423-499-9552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 Market St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Chattanooga",
            "state": "TN",
            "postal_code": "374021226",
            "country_code": "US",
            "telephone_number": "423-899-0431",
            "fax_number": "423-499-9552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1005 Executive Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Hixson",
            "state": "TN",
            "postal_code": "373437904",
            "country_code": "US",
            "telephone_number": "423-899-0431",
            "fax_number": "423-499-9552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "AMBER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-26",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN196795",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "19802",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis Prok, PA- C
• Prolex Medical Services, Inc
• Promed Equipment Company, LLC
• Michael C. Prostko, M.D.
• Protech Medical LLC
• Allison Paige Provey, PHARMD
• Brooklin Michael Pruehs, D.D.S.
• Cady Pruitt
• Janice W Pruitt
• Jennifer Lynn Pruitt, RDN, LDN

• Family Nurse Practitioner in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.