Healthcare Provider Details

I. General information

NPI: 1649840802
Provider Name (Legal Business Name): AMANDA RACHEL SLONIKER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W ASHLAND ST
NEVADA MO
64772-1710
US

IV. Provider business mailing address

1500 W ASHLAND ST
NEVADA MO
64772-1710
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-2666
  • Fax:
Mailing address:
  • Phone: 417-667-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2004031483
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: