Provider Demographics
NPI:1497220594
Name:WHISTLER, AMANDA FAYE (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FAYE
Last Name:WHISTLER
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 1:147 N LACEY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2498
Mailing Address - Country:US
Mailing Address - Phone:573-332-1900
Mailing Address - Fax:
Practice Address - Street 1:147 N LACEY ST STE 1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2498
Practice Address - Country:US
Practice Address - Phone:573-332-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF07181569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily