Provider Demographics
NPI:1922198688
Name:HERFKENS-AMPLEMAN, KATHRYN A (FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:HERFKENS-AMPLEMAN
Suffix:
Gender:F
Credentials:FNP
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 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:332 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1861
Practice Address - Country:US
Practice Address - Phone:417-732-5050
Practice Address - Fax:417-732-8061
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO145564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424668408Medicaid
MO000080660Medicare PIN
MO000080651Medicare PIN
MOS85507Medicare UPIN