Provider Demographics
NPI:1902205297
Name:GROUNDS, AMANDA K (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:GROUNDS
Suffix:
Gender:F
Credentials:APRN, 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:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-8355
Mailing Address - Fax:
Practice Address - Street 1:3202 MCINTOSH CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3646
Practice Address - Country:US
Practice Address - Phone:417-347-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014028415363LF0000X
KS76443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2005022858OtherRN LICENSE NUMBER
F0814211OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION NUMBER
MO2014028415OtherFAMILY NURSE PRACTITIONER LICENSE NUMBER