Provider Demographics
NPI:1679889356
Name:MOORHOUSE, AMANDA S (APN)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:S
Last Name:MOORHOUSE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70403
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5611
Practice Address - Country:US
Practice Address - Phone:423-439-7371
Practice Address - Fax:423-232-0420
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN15468OtherAPN
TN176776OtherEMT LICENSE
TNRN132686OtherRN LICENSE