Individual
AMANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
940 W MOUNT VERNON ST STE 220, NIXA, MO 65714-9613
(417) 724-5437
Mailing address
940 W MOUNT VERNON ST STE 220, NIXA, MO 65714-9613
(417) 724-5437
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2011022742
MO
363LP0200X
Pediatric Nurse Practitioner
Primary
2020008008
MO
Other
Enumeration date
03/02/2020
Last updated
03/11/2020
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