Healthcare Provider Details

I. General information

NPI: 1518522721
Provider Name (Legal Business Name): AMBER WITHINGTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 FLEMING ST
GARDEN CITY KS
67846-5972
US

IV. Provider business mailing address

302 FLEMING ST
GARDEN CITY KS
67846-5972
US

V. Phone/Fax

Practice location:
  • Phone: 620-271-1424
  • Fax:
Mailing address:
  • Phone: 620-271-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79912-012
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-73177
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: