Amanda Nicole Breedlove, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

2012026927 Issued in MO

Practice address

1203 Smizer Mill Rd
Suite 100
Fenton, MO 63026-3483

Phone

(636) 717-1414

NPI assigned

Aug 13, 2012

Last updated

Feb 28, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mercy Aco Clinical Services Inc

  • Neurology Physician
  • Chesterfield, MO
  • NPI 1063965093
  NPD
• Mercy Clinic East Communities

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1851335228
  NPD

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362009600000",
    "number": "1235486952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 SMIZER MILL RD",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630263483",
            "telephone_number": "636-717-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 SMIZER MILL RD",
            "address_2": "SUITE 100",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630263483",
            "telephone_number": "636-717-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREEDLOVE",
        "first_name": "AMANDA",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-13",
        "last_updated": "2013-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2012026927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Marie Boon, APN
• Aaron Bornstein, D.O.
• Lawrence Vincent Boveri, MD
• Stephen Angelo Boveri, MD
• Michelle E Braun, RN BSN
• Brian K Kindel OD PC
• Jacob Daniel Briegleb, DC
• Lindsey N Bright, CRNA
• Brookwood LLC
• Allison Kate Brown, FNP

• Pediatric Nurse Practitioner in Fenton, MO
• Providers in Fenton, MO by specialty
• Pediatric Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.