Provider Demographics
NPI:1134557770
Name:GARVEY, AMY DIANE (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DIANE
Last Name:GARVEY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 FLORISSANT OAKS SHOP CTR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-3934
Mailing Address - Country:US
Mailing Address - Phone:314-831-8600
Mailing Address - Fax:314-831-0086
Practice Address - Street 1:91 FLORISSANT OAKS SHOP CTR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-3934
Practice Address - Country:US
Practice Address - Phone:314-831-8600
Practice Address - Fax:314-831-0086
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013037724363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health