Provider Demographics
NPI:1194271163
Name:KEARNEY, AMANDA MARIA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIA
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 WELDON SPRING PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-9101
Mailing Address - Country:US
Mailing Address - Phone:636-949-5760
Mailing Address - Fax:866-440-9231
Practice Address - Street 1:4801 WELDON SPRING PKWY STE 300
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-9101
Practice Address - Country:US
Practice Address - Phone:636-949-5760
Practice Address - Fax:866-440-9231
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018020945363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health