MEDICARE: AMY EILEEN MOENNING NP

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
1	363LF0000X	Family Nurse Practitioner	2023063579	MO

General Provider Information

NPI Number	:	1174203939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY EILEEN MOENNING NP

Provider Business Mailing Address
First Line	:	1011 S EAST ST
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-1399
Country	:	US
Telephone Number	:	417-466-7191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 S EAST ST
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-1399
Country	:	US
Telephone Number	:	417-466-7191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2023
Last Update Date	:	07/18/2023

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