Healthcare Provider Details

I. General information

NPI: 1831054915
Provider Name (Legal Business Name): COURTNEY AMANDA WILBANKS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

707 N KENTUCKY AVE # 2
WEST PLAINS MO
65775-2085
US

IV. Provider business mailing address

707 N KENTUCKY AVE # 2
WEST PLAINS MO
65775-2085
US

V. Phone/Fax

Practice location:
  • Phone: 417-222-2498
  • Fax:
Mailing address:
  • Phone: 417-222-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025048315
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: