Healthcare Provider Details

I. General information

NPI: 1649575317
Provider Name (Legal Business Name): AMANDA JEAN CRISLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JEAN CHADWICK RN

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-3627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5375314122
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-75314
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: