Individual
AMANDA SUE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2820 E ROCK HAVEN RD, STE. 100, HARRISONVILLE, MO 64701-4411
(816) 380-3582
(816) 380-6964
Mailing address
2820 E ROCK HAVEN RD, STE. 100, HARRISONVILLE, MO 64701-4411
(816) 380-3582
(816) 380-6964
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2012033367
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356692701
—
MO
Enumeration date
09/25/2012
Last updated
04/27/2015
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