Individual
AMANDA KAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3600 S NATIONAL AVE, SPRINGFIELD, MO 65807-7311
(417) 322-6622
(417) 350-1935
Mailing address
3600 S NATIONAL AVE, SPRINGFIELD, MO 65807-7311
(417) 322-6622
(417) 350-1935
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2016026844
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2022002430
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
221292
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290473758
—
AR
05
—
420112194
—
MO
Enumeration date
07/08/2022
Last updated
04/21/2023
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