Healthcare Provider Details

I. General information

NPI: 1235610304
Provider Name (Legal Business Name): AMY CREASON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E LOCKLING ST
BROOKFIELD MO
64628-2337
US

IV. Provider business mailing address

10635 DELTA DR
BROWNING MO
64630-9775
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-1050
  • Fax: 660-258-1052
Mailing address:
  • Phone: 660-946-4594
  • Fax: 660-258-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018021097
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: