Provider Demographics
NPI:1578193637
Name:BAREMORE, AMY CHRISANDRA (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISANDRA
Last Name:BAREMORE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 E 20TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-5981
Mailing Address - Country:US
Mailing Address - Phone:417-812-5103
Mailing Address - Fax:
Practice Address - Street 1:3625 E 20TH ST STE B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-5981
Practice Address - Country:US
Practice Address - Phone:417-812-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR219140363LP0808X
KS53-82623-061363LP0808X
MO2020001756363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420079833Medicaid
AR282154758Medicaid