Amanda McConville

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

15536 Issued in WI

Practice address

2901 Hunters TRL
Portage, WI 53901-3403

Phone

(608) 742-5518

Fax

(608) 268-9780

NPI assigned

Jul 12, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Community Service Associates, SCGroup PAC ID 8426948746, 34 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Service Associates, SC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portage, WI
  • NPI 1780610923
  Medicare reassignment Care Compare group NPD
• WKM Psychology Clinics, Inc.

  • Psychologist
  • Platteville, WI
  • NPI 1659387009
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774569600000",
    "number": "1063259489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 PRAIRIE HEIGHTS DR",
            "city": "VERONA",
            "state": "WI",
            "postal_code": "535932333",
            "telephone_number": "608-370-3641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 HUNTERS TRL",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539013403",
            "telephone_number": "608-742-5518",
            "fax_number": "608-268-9780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119 Prairie Heights Dr",
            "address_purpose": "LOCATION",
            "city": "Verona",
            "state": "WI",
            "postal_code": "535932333",
            "country_code": "US",
            "telephone_number": "608-370-3641",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2702 International Ln Ste 102",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537043117",
            "country_code": "US",
            "telephone_number": "608-405-5712",
            "fax_number": "608-268-9780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCONVILLE",
        "first_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-12",
        "last_updated": "2026-03-27",
        "certification_date": "2026-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "15536",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "15536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100367843",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Marie Marginean, RN
• Mary Ellen Miller, Ms, LPC, LLC
• John Clifton Mattern, PHARM.D.
• Amy Lynn Mattson, R.N.
• Jacob May
• Dorothy Mae McCurdy, SAC
• Sydney C McDonaldd, MSW
• Chelsey M Medsker, ABOC, NCLEC
• Claire Meixelsperger, OTR
• Alexander B Mentzel, MS, LPC-IT

• Psychiatric/Mental Health Nurse Practitioner in Portage, WI
• Providers in Portage, WI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.