Healthcare Provider Details

I. General information

NPI: 1235026105
Provider Name (Legal Business Name): AMY MARIE CERNIK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MARIE REED

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 US HIGHWAY 61 STE G1000
FESTUS MO
63028-4136
US

IV. Provider business mailing address

1390 US HIGHWAY 61 STE G1000
FESTUS MO
63028-4136
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-7400
  • Fax: 636-933-7403
Mailing address:
  • Phone: 636-933-7400
  • Fax: 636-933-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025024112
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2021047308
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: