Healthcare Provider Details

I. General information

NPI: 1134862188
Provider Name (Legal Business Name): AMANDA STALLINGS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BROADHURST DO

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 W 151ST ST
LEAWOOD KS
66224-8700
US

IV. Provider business mailing address

5405 W 151ST ST
LEAWOOD KS
66224-8700
US

V. Phone/Fax

Practice location:
  • Phone: 913-901-5001
  • Fax: 913-901-5051
Mailing address:
  • Phone: 913-901-5001
  • Fax: 913-901-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number05-53351
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: