Active NPI
Amy I. Whitaker, FNP
- Family Nurse Practitioner
- Rolla, MO
National Provider Identifier
1508902354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 064070
- Practice address
- 1050 W 10TH St
Rolla, MO 65401 - Phone
- (573) 364-7545
- Fax
- (573) 368-3672
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 064070 | MO | Primary |
Addresses
Primary practice location
1050 W 10TH St
Rolla, MO 65401
Mailing address
P.O. Box 579
Rolla, MO 65402
Phone (573) 458-3425
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 428416309 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 064070 | MO | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319500800000",
"number": "1508902354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 579",
"city": "ROLLA",
"state": "MO",
"postal_code": "65402",
"telephone_number": "573-458-3425",
"fax_number": "573-426-2282"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 W 10TH ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "65401",
"telephone_number": "573-364-7545",
"fax_number": "573-368-3672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITAKER",
"first_name": "AMY",
"middle_name": "I.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2011-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "064070",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "428416309",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.