MEDICARE: AMANDA KIRKHAM FNP/PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	235701	AZ
2	363LF0000X	Family Nurse Practitioner	235701	AZ

General Provider Information

NPI Number	:	1669010757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KIRKHAM FNP/PMHNP

Provider Business Mailing Address
First Line	:	2036 N GILBERT RD STE 2-500
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-2139
Country	:	US
Telephone Number	:	623-205-0456
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 W BROWN RD STE 3001
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-3225
Country	:	US
Telephone Number	:	623-205-0456
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2019
Last Update Date	:	03/27/2026

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