Provider Demographics
NPI:1811338767
Name:HARRELL, AMY (APN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2472
Mailing Address - Country:US
Mailing Address - Phone:537-635-6350
Mailing Address - Fax:573-644-6657
Practice Address - Street 1:1500 SOUTHWEST BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2472
Practice Address - Country:US
Practice Address - Phone:537-635-6350
Practice Address - Fax:573-644-6657
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013017567363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner