Provider Demographics
NPI:1225782683
Name:TAINTER, AMANDA E (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:E
Last Name:TAINTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:WORKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1965 S FREMONT AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2258
Mailing Address - Country:US
Mailing Address - Phone:417-820-3809
Mailing Address - Fax:
Practice Address - Street 1:1965 S FREMONT AVE STE 230
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2258
Practice Address - Country:US
Practice Address - Phone:417-820-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022004923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant