Healthcare Provider Details

I. General information

NPI: 1598228504
Provider Name (Legal Business Name): AMBER RENEE HENDRIX FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 N JEFFERSON ST
CARROLLTON MO
64633-1945
US

IV. Provider business mailing address

825 S BUSINESS HIGHWAY 13
LEXINGTON MO
64067-1515
US

V. Phone/Fax

Practice location:
  • Phone: 816-249-1521
  • Fax:
Mailing address:
  • Phone: 660-259-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014009165
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: