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NPI Code Detail

MEDICARE: DR. AMY C. PATELLA PSY.D.

MEDICARE: DR. AMY C. PATELLA PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist2009026801MO
2103TC0700XClinical PsychologistLP6507MN

General Provider Information

NPI Number : 1053541987
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY C. PATELLA PSY.D.
Provider Business Mailing Address
First Line : 530 E 34TH ST
Second Line : P.O. BOX 2526
City : JOPLIN
State : MO
Zip : 64804-3924
Country : US
Telephone Number : 417-347-7520
Fax Number : 417-347-7519
Provider Business Practice Location Address
First Line : 2428 E 117TH ST
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-1269
Country : US
Telephone Number : 612-444-3000
Fax Number : 612-444-9000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2009
Last Update Date : 09/19/2023

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