Amanda L Wicker, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

2003028629 Issued in MO

Practice address

106 S Washington St
East Prairie, MO 63845-1526

Phone

(573) 649-9411

Fax

(573) 649-9442

NPI assigned

Jun 21, 2007

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Because We Care

  • Child Physical Disabilities Respite Care
  • East Prairie, MO
  • NPI 1942322730
  NPD (past) Authorized official

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265637987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 S WASHINGTON ST",
            "city": "EAST PRAIRIE",
            "state": "MO",
            "postal_code": "638451526",
            "telephone_number": "573-649-9411",
            "fax_number": "573-649-9442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 S WASHINGTON ST",
            "city": "EAST PRAIRIE",
            "state": "MO",
            "postal_code": "638451526",
            "telephone_number": "573-649-9411",
            "fax_number": "573-649-9442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKER",
        "first_name": "AMANDA",
        "middle_name": "L",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MO",
            "license": "2003028629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Skillset LLC
• Joann Lucille Smithson, COTA
• Ryan Blake Smithson
• Southeast Missouri Health Network
• Miranda B Thurman, APRN, FNP, BC

• All providers in East Prairie, MO
• Licensed Practical Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.