Healthcare Provider Details

I. General information

NPI: 1205748878
Provider Name (Legal Business Name): GLASS MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 E 32ND ST STE 101
JOPLIN MO
64804-3018
US

IV. Provider business mailing address

2011 E 32ND ST STE 101
JOPLIN MO
64804-3018
US

V. Phone/Fax

Practice location:
  • Phone: 417-206-6710
  • Fax:
Mailing address:
  • Phone: 417-206-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA HARRELL
Title or Position: OWNER AND CEO
Credential: DO FACP DABOM
Phone: 816-803-5615