Healthcare Provider Details

I. General information

NPI: 1700242005
Provider Name (Legal Business Name): AMANDA L. HUNTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY SUITE 580
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

PO BOX 504944
SAINT LOUIS MO
63150-4944
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-8555
  • Fax: 417-556-8553
Mailing address:
  • Phone: 417-829-4620
  • Fax: 417-829-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015044897
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: