Healthcare Provider Details

I. General information

NPI: 1285956904
Provider Name (Legal Business Name): AMANDA K. WINFREY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MAIN ST STE 2
CASSVILLE MO
65625-1670
US

IV. Provider business mailing address

105 MAIN ST STE 2
CASSVILLE MO
65625-1670
US

V. Phone/Fax

Practice location:
  • Phone: 417-665-1165
  • Fax: 417-250-2668
Mailing address:
  • Phone: 417-665-1165
  • Fax: 417-250-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003469
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1618785
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2006001241
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: