Healthcare Provider Details

I. General information

NPI: 1104374271
Provider Name (Legal Business Name): AMANDA DARBY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 LINDELL BLVD STE 200
SAINT LOUIS MO
63108-3725
US

IV. Provider business mailing address

40 S MAIN ST STE 1300
MEMPHIS TN
38103-5513
US

V. Phone/Fax

Practice location:
  • Phone: 866-949-0108
  • Fax:
Mailing address:
  • Phone: 866-949-0108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016034577
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: