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NPI Code Detail

MEDICARE: XANDRA MICHELLE BAZAR AMISTAD BSN, MSN, PMHNP-BC

MEDICARE: XANDRA MICHELLE BAZAR AMISTAD BSN, MSN, PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner2025020595MO

General Provider Information

NPI Number : 1629963665
Entity Type Code : Individual
Provider Name (Legal Business Name) : XANDRA MICHELLE BAZAR AMISTAD BSN, MSN, PMHNP-BC
Provider Business Mailing Address
First Line : 1201 INTERNATIONAL DR
Second Line :
City : COLUMBIA
State : MO
Zip : 65202-1612
Country : US
Telephone Number : 573-615-7188
Fax Number :
Provider Business Practice Location Address
First Line : 1201 INTERNATIONAL DR
Second Line :
City : COLUMBIA
State : MO
Zip : 65202-1612
Country : US
Telephone Number : 573-615-7188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2025
Last Update Date : 08/15/2025

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