Individual provider · Type 1 NPI
Amanda Jackson, CPNP
Pediatric Nurse Practitioner · Nixa, MO
NPI number
1205460045
Active
Practice location
940 W Mount Vernon St Ste 220
Nixa, MO 65714-9613
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 2011022742 (MO) |
| Pediatric Nurse Practitioner Primary | 363LP0200X | 2020008008 (MO) |
Pediatric Nurse Practitioner: Definition to come...
Another provider at this address
About NPI 1205460045
Amanda Jackson, CPNP's National Provider Identifier is 1205460045, issued on Mar 2, 2020. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Nixa, MO. The record was last updated on Mar 11, 2020.