Healthcare Provider Details

I. General information

NPI: 1225714785
Provider Name (Legal Business Name): AMANDA M SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 5TH ST
WASHINGTON MO
63090-3127
US

IV. Provider business mailing address

901 E 5TH ST
WASHINGTON MO
63090-3127
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8011
  • Fax: 636-239-8058
Mailing address:
  • Phone: 636-239-8011
  • Fax: 636-239-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2026034151
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: