Healthcare Provider Details

I. General information

NPI: 1346730561
Provider Name (Legal Business Name): AMANDA KANIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 E 2ND ST
BECKEMEYER IL
62219-4202
US

IV. Provider business mailing address

291 E 2ND ST
BECKEMEYER IL
62219-4202
US

V. Phone/Fax

Practice location:
  • Phone: 618-484-9030
  • Fax:
Mailing address:
  • Phone: 618-484-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016324
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: