Provider Demographics
NPI:1245470624
Name:LANDT, AMANDA RENEE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:RENEE
Last Name:LANDT
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:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-0758
Mailing Address - Country:US
Mailing Address - Phone:417-451-4447
Mailing Address - Fax:417-451-4448
Practice Address - Street 1:1504 N BUSINESS 49
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-6883
Practice Address - Country:US
Practice Address - Phone:417-451-4447
Practice Address - Fax:417-451-4448
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1245470624Medicaid
KS200612640BMedicaid
KS200612640BMedicaid
MOMA2082062Medicare PIN