Healthcare Provider Details

I. General information

NPI: 1508232885
Provider Name (Legal Business Name): AMANDA NOELLE HESTAND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE STE 1122
SPRINGFIELD MO
65807-6090
US

IV. Provider business mailing address

PO BOX 7411626
CHICAGO IL
60674-5626
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-7728
  • Fax: 417-269-7729
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2019008194
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: