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General NPI Number Information
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NPI Number | 1477792869
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Entity Type | Individual
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Provider Name | AMANDA M. CRIM PA
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Gender | Female
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 94 MAIN ST
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City | CASSVILLE
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State | MO
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Zip | 65625-1610
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Country | US
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Telephone | 417-847-6000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 504274
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City | SAINT LOUIS
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State | MO
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Zip | 63150-4274
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Country | US
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Telephone | 855-420-7900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2009001274
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License Number State | MO
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