Active NPI
Amanda Diercks, N.P.
- Nurse Practitioner
- Saint Louis, MO
National Provider Identifier
1679946156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 2015039589
- Practice address
- 5347 Glencullen Way
Saint Louis, MO 63128-4229 - Phone
- (314) 488-4289
- NPI assigned
- Nov 5, 2015
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 2015039589 | MO | Primary |
Addresses
Primary practice location
5347 Glencullen Way
Saint Louis, MO 63128-4229
Mailing address
5347 Glencullen Way
Saint Louis, MO 63128-4229
Phone (314) 488-4289
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2015039589 | 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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Life Line Community Healthcare New Jersey, LLC | Nurse Practitioner | Current | Accepting new patients |
Locations
70 Niagara St
Ste 13
Buffalo, NY 14202
6111 Oak Tree Blvd
Ste 301
Independence, OH 44131
Phone (216) 581-6556
Organizations & group practices 1
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.
-
- Nurse Practitioner
- Independence, OH
- NPI 1093118853
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1446681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446681600000",
"number": "1679946156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5347 GLENCULLEN WAY",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631284229",
"telephone_number": "314-488-4289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5347 GLENCULLEN WAY",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631284229",
"telephone_number": "314-488-4289"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIERCKS",
"first_name": "AMANDA",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-05",
"last_updated": "2015-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MO",
"license": "2015039589",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2015039589",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.