Healthcare Provider Details

I. General information

NPI: 1659960979
Provider Name (Legal Business Name): AMANDA J CHAPMAN MSN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S HICKORY ST
MOUNT VERNON MO
65712-1407
US

IV. Provider business mailing address

108 S HICKORY ST
MOUNT VERNON MO
65712-1407
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-4110
  • Fax: 417-466-4255
Mailing address:
  • Phone: 417-466-4110
  • Fax: 417-466-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021008231
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2011021027
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: