Individual
AMY I. WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1050 W 10TH ST, ROLLA, MO 65401
(573) 364-7545
(573) 368-3672
Mailing address
P.O. BOX 579, ROLLA, MO 65402
(573) 458-3425
(573) 426-2282
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
064070
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
428416309
—
MO
Enumeration date
01/29/2007
Last updated
10/25/2011
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