Amanda K Eddy, ATC/L

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2004001633 Issued in MO

Practice address

3019 Fair St
Poplar Bluff, MO 63901-7044

Phone

(573) 714-2981

Fax

(573) 778-3958

NPI assigned

Jun 13, 2012

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.

• Ozark Physical Medicine Center for Operations Ozark Plaza and Medical

  • Physical Therapy Clinic/Center
  • Poplar Bluff, MO
  • NPI 1053821322
  NPD (past)

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

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339545600000",
    "number": "1386906535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3019 FAIR ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639017044",
            "telephone_number": "573-714-2981",
            "fax_number": "573-778-3958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3019 FAIR ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639017044",
            "telephone_number": "573-714-2981",
            "fax_number": "573-778-3958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDDY",
        "first_name": "AMANDA",
        "middle_name": "K",
        "credential": "ATC/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-13",
        "last_updated": "2012-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2004001633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eastside Pharmacy, Inc.
• Betty Eaton
• Patricia D Eaton, MSN, AGNP,PMHNP
• Robert Shane Eaton
• Ebo MD of Poplar Bluff LLC
• Stacy Lee Edgar, FNP-C
• Joyce Ann Edington
• Ashley Michelle Edmonds
• Jessica Marie Edwards
• Rebecca Ann Eggers

• Athletic Trainer in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; 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.