Healthcare Provider Details

I. General information

NPI: 1598497216
Provider Name (Legal Business Name): AMANDA ESSEX HULL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA SARI ESSEX MD

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 E SAINT CHARLES RD # DC105.00
COLUMBIA MO
65202-0196
US

IV. Provider business mailing address

7115 E SAINT CHARLES RD # DC105.00
COLUMBIA MO
65202-0196
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-6851
  • Fax: 573-884-0293
Mailing address:
  • Phone: 573-884-6851
  • Fax: 573-884-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2022024941
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: