Provider Demographics
NPI:1619743143
Name:PAGE, AMANDA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:PAGE
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 1:1308 E SILER PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2566
Mailing Address - Country:US
Mailing Address - Phone:417-379-8304
Mailing Address - Fax:
Practice Address - Street 1:448 STATE HIGHWAY 248 STE 140
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3725
Practice Address - Country:US
Practice Address - Phone:417-337-9808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015003834163W00000X
MO2024001621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse