Provider Demographics
NPI:1114438165
Name:BROWN, AMANDA CAELIN (NP-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAELIN
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4595 STATE ROUTE AB
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-7300
Mailing Address - Country:US
Mailing Address - Phone:417-372-0323
Mailing Address - Fax:
Practice Address - Street 1:9104 STATE HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MO
Practice Address - Zip Code:65588-8389
Practice Address - Country:US
Practice Address - Phone:573-325-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013010077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily