| Doctor Name: | AMANDA SUE WILSON |
| NPI Number: | 1356692701 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 2012033367 |
| Business Practice Address: | 2820 E Rock Haven Rd Ste. 100 Harrisonville, MO - 647014411 |
| Business Phone Number: | 8163803582 |
| Business Fax Number: | 8163806964 |
| Mailing Address: | 2820 E Rock Haven Rd, Ste. 100 HARRISONVILLE |
| State: | MO |
| Postal Code: | 647014411 |
| Phone Number: | 8163803582 |
| Fax Number: | 8163806964 |
| NPI Enumeration Date: | 09/25/2012 |
| NPI Last Update Date: | 04/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2012033367 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |