MRS. AMANDA GAIL MOFFITT (NPI# 1568800647) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568800647 |
| Entity Type | Individual |
| Full Name | MRS. AMANDA GAIL MOFFITT |
| Credential | CRNA |
| Practice Address |
3100 Oak Grove Rd Poplar Bluff MO 63901-1573 |
| Mailing Address |
Rr 1 Box 34 Ellsinore MO 63937-9704 |
| Practice Telephone | 5837181863 |
| Mailing Telephone | 5737181863 |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 2006022082 | MO | Nursing Service Providers |
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 092728 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4098 Highway Dd, Fisk, MO 639407155 | 5737181863 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053673467 | Amanda Jo Moffitt | Licensed Practical Nurse | 3619 Chamberlin Rd., Weedsport, NY 13166 | 2012-06-12 |
| Street Address |
3100 OAK GROVE RD |
| City | POPLAR BLUFF |
| State | MO |
| Zip Code | 63901-1573 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356305684 | Tirso J Aldana | Internal Medicine | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2006-04-13 |
| 1558985911 | Poplar Bluff Regional Medical Center LLC | Medicare Defined Swing Bed Unit | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2020-06-02 |
| 1073133237 | Poplar Bluff Regional Medical Center | Clinical Medical Laboratory | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2020-04-17 |
| 1568946515 | Carol Lee Pratt | Nurse Practitioner | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2018-09-15 |
| 1457842163 | Rachel Matthews | Social Worker | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2018-05-29 |
| 1669995155 | Stacy Lee Taylor | Registered Nurse | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2017-07-17 |
| 1700314010 | Miranda Krishna | Nurse Practitioner | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2017-05-31 |
| 1689110611 | Prachi Avinash Pophali | Internal Medicine | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2017-01-14 |
| 1588118020 | Abhishek Ambarisha Bhandiwad | Internal Medicine | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2016-08-13 |
| 1982056545 | Butler Physician Services, LLC | Pediatrics | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2016-07-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1285271239 | Front Door Wellness LLC | Physical Therapist | Front Door Wellness LLC, 5835 Quail Meadows Drive, Poplar Bluff, MO 63901 | 2019-12-09 |
| 1104470368 | Andrew Akindutire | Dentist | 3101 Oak Groove Rd., Suite 6, Poplar Bluff, MO 63901 | 2019-07-26 |
| 1780195966 | Midwest Equipment Srv Systems LLC | Technician, Pathology | 2400 Lucy Lee Parkway, Suite C, Poplar Bluff, MO 63901 | 2017-10-16 |
| 1801259387 | Richard Justin Huber | Technician, Other | 3005 Warrior Ln, Poplar Bluff, MO 63901 | 2016-04-01 |
| 1699136275 | Donja Kirkland | Recreation Therapist | 1910a Greenwood Dr., Suite D, Poplar Bluff, MO 63901 | 2016-03-10 |
| 1760866867 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 3050 Tucker Road, Poplar Bluff, MO 63901 | 2015-07-17 |
| 1407246390 | Lisa Marie Payne | Physical Therapist | 4358c Highway Pp, Poplar Bluff, MO 63901 | 2015-01-29 |
| 1700202488 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 1602 W. Harper Street, Poplar Bluff, MO 63901 | 2014-03-05 |
| 1932521648 | Essential Family Healthcare, LLC | Clinic/Center | 1369 North Westwood Blvd., Poplar Bluff, MO 63901 | 2014-01-15 |
| Find all providers in zip 63901 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801137013 | Clinical Colleagues Inc | Nurse Anesthetist, Certified Registered | 3100 Oak Grove, Poplar Bluff, MN 63902 | 2013-03-13 |
| 1447576962 | Joann Turner | Nurse Anesthetist, Certified Registered | 784 County Road 475, Poplar Bluff, MO 63901-6671 | 2010-04-08 |
| 1477532430 | Donald Foust | Nurse Anesthetist, Certified Registered | 219 Physicians Park, Poplar Bluff, MO 63901-3956 | 2006-01-10 |
| 1578958377 | Jennifer Moss | Nurse Anesthetist, Certified Registered | 3100 Oak Grove Rd, Poplar Bluff, MO 63901-1573 | 2015-03-30 |
| 1215366307 | Guardian Anesthesia Associates LLC | Nurse Anesthetist, Certified Registered | 219 Physicians Park, Poplar Bluff, MO 63901-3956 | 2013-11-08 |
| 1770851743 | Lisa Renee Carroll | Nurse Anesthetist, Certified Registered | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2011-12-06 |
| 1699080143 | Southeast Missouri Anesthesia Partners LLC | Nurse Anesthetist, Certified Registered | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2010-08-09 |
| 1780903021 | Charles Matthew Hollis | Nurse Anesthetist, Certified Registered | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2010-05-26 |
| 1730330168 | Poplar Bluff Regional Medical Center LLC | Nurse Anesthetist, Certified Registered | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2008-10-03 |
| 1174796601 | Timothy Paul Kordick | Nurse Anesthetist, Certified Registered | 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396 | 2008-04-04 |
| Find all providers in POPLAR BLUFF | ||||
| City | POPLAR BLUFF |
| Zip Code | 63901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.