Provider Demographics
NPI:1689264335
Name:COPENHAVER, AMANDA D (FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:COPENHAVER
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 1:712 S FOX RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9079
Mailing Address - Country:US
Mailing Address - Phone:816-590-2587
Mailing Address - Fax:
Practice Address - Street 1:712 S FOX RIDGE DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9079
Practice Address - Country:US
Practice Address - Phone:816-590-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021002930207Q00000X, 363LF0000X
KS53-80080-032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine