Healthcare Provider Details

I. General information

NPI: 1245223791
Provider Name (Legal Business Name): AMY L KURTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY L SANDERS PA-C

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

IV. Provider business mailing address

1 S KEENE ST
COLUMBIA MO
65201-7199
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-2402
  • Fax: 573-443-0574
Mailing address:
  • Phone: 573-443-2402
  • Fax: 573-443-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2004029289
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: