Provider Demographics
NPI:1184710832
Name:LINN, AMY LYNN (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:LINN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1135 E LAKEWOOD ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2434
Mailing Address - Country:US
Mailing Address - Phone:417-887-5500
Mailing Address - Fax:417-887-0674
Practice Address - Street 1:1135 E LAKEWOOD ST
Practice Address - Street 2:SUITE 112
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2434
Practice Address - Country:US
Practice Address - Phone:417-887-5500
Practice Address - Fax:417-887-0674
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO136736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425281201Medicaid
MO425281201Medicaid