Provider Demographics
NPI:1629893268
Name:SMITH, AMY CHRISTINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-6154
Mailing Address - Country:US
Mailing Address - Phone:636-393-9499
Mailing Address - Fax:
Practice Address - Street 1:39 SILO DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-4917
Practice Address - Country:US
Practice Address - Phone:636-234-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024045261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily