Provider Demographics
NPI:1609233733
Name:COMFORT, AMANDA (MSN, FPMHNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:COMFORT
Suffix:
Gender:F
Credentials:MSN, FPMHNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:TITTOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5111
Practice Address - Street 1:1300 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4264
Practice Address - Country:US
Practice Address - Phone:417-761-5000
Practice Address - Fax:417-761-5111
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004622363LP0808X
MO2018006685363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR478761YJTPMedicare UPIN