Provider Demographics
NPI:1316398415
Name:KILZER, AMANDA JOY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOY
Last Name:KILZER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5401
Mailing Address - Country:US
Mailing Address - Phone:618-344-3046
Mailing Address - Fax:618-344-5284
Practice Address - Street 1:2401 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5401
Practice Address - Country:US
Practice Address - Phone:618-344-3046
Practice Address - Fax:618-344-5284
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily