Individual
AMANDA GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
92 MAIN ST, CASSVILLE, MO 65625-1610
(417) 847-5225
(417) 847-5425
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2014023482
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
07/18/2014
Last updated
07/18/2014
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