Individual
MS. AMY DIANNA WALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
203 S WASHINGTON ST, FARMINGTON, MO 63640-1836
(573) 664-1047
Mailing address
203 S WASHINGTON ST, FARMINGTON, MO 63640-1836
(573) 664-1047
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2015006782
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420021276
—
MO
Enumeration date
02/23/2015
Last updated
12/17/2025
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