Healthcare Provider Details

I. General information

NPI: 1770807737
Provider Name (Legal Business Name): AMANDA JO MILLIGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 N JEFFERSON AVE
SPRINGFIELD MO
65802-1917
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-4353
  • Fax: 417-269-4869
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-4869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2010004417
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: