Healthcare Provider Details

I. General information

NPI: 1750717385
Provider Name (Legal Business Name): AMANDA S GILBERT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E PRIMROSE ST STE E
SPRINGFIELD MO
65807-5233
US

IV. Provider business mailing address

222 E PRIMROSE ST STE E
SPRINGFIELD MO
65807-5233
US

V. Phone/Fax

Practice location:
  • Phone: 417-888-0167
  • Fax:
Mailing address:
  • Phone: 417-553-1080
  • Fax: 888-472-5145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022037796
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: