Provider Demographics
NPI:1114391067
Name:MORAN, AMY ELIZABETH (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:MORAN
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Gender:F
Credentials:AGPCNP-BC
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Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-525-4325
Mailing Address - Fax:314-525-4365
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-525-4325
Practice Address - Fax:314-525-4365
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015040100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health