Provider Demographics
NPI:1922881713
Name:TERWILLIGER, AMANDA SHEA (CRNA)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:SHEA
Last Name:TERWILLIGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 MULLINS LN
Mailing Address - Street 2:
Mailing Address - City:BETHEL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:38315-4465
Mailing Address - Country:US
Mailing Address - Phone:731-439-3379
Mailing Address - Fax:
Practice Address - Street 1:803 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2432
Practice Address - Country:US
Practice Address - Phone:270-762-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4008692367500000X
TN231249163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse