Provider Demographics
NPI:1164822375
Name:NORSWORTHY GARRISON, AMY DAWN (CNM, CPM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DAWN
Last Name:NORSWORTHY GARRISON
Suffix:
Gender:F
Credentials:CNM, CPM
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DAWN
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM, CPM
Mailing Address - Street 1:8302 COUNTY ROAD 1740
Mailing Address - Street 2:
Mailing Address - City:PEACE VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:65788-9748
Mailing Address - Country:US
Mailing Address - Phone:417-293-2691
Mailing Address - Fax:
Practice Address - Street 1:8302 COUNTY ROAD 1740
Practice Address - Street 2:
Practice Address - City:PEACE VALLEY
Practice Address - State:MO
Practice Address - Zip Code:65788-9748
Practice Address - Country:US
Practice Address - Phone:417-293-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999135585367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife