Amanda N Lawrence, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2011005771 Issued in MO

Practice address

16759 Main St
Ste. 201
Wildwood, MO 63040-1232

Phone

(636) 821-1661

Fax

(636) 821-1665

NPI assigned

Apr 19, 2011

Last updated

Jan 18, 2017By 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

Enrolled in MO

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

Physician Assistant

Education

Saint Louis University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alliance Health and Dermatology, LLCGroup PAC ID 5597094961, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Alliance Health and Dermatology, LLC

  • Clinic/Center
  • Cape Girardeau, MO
  • NPI 1952958449
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1295026631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16759 MAIN ST",
            "address_2": "STE. 201",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630401232",
            "telephone_number": "636-821-1661",
            "fax_number": "636-821-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16759 MAIN ST",
            "address_2": "STE. 201",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630401232",
            "telephone_number": "636-821-1661",
            "fax_number": "636-821-1665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "AMANDA",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-19",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2011005771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Victoria Kotva, PHARMD
• Kara Labedz
• Mary Lakey, LPC
• Jonathon E Langenbacher, D.C.
• Steven R. Lawless, D.C.
• Jana Leabig
• Leo Warren MD PC
• LH Chiropractic LLC
• Collette T. Lucas, DDS
• Rachael Grace Macgregor, DPT, DMT, FAAOMPT

• Physician Assistant in Wildwood, MO
• Providers in Wildwood, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.