Healthcare Provider Details

I. General information

NPI: 1902138001
Provider Name (Legal Business Name): AMY MARIE CARR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8629 BLUEJACKET ST SUITE 102
LENEXA KS
66214-1604
US

IV. Provider business mailing address

8629 BLUEJACKET ST SUITE 102
LENEXA KS
66214-1604
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-0500
  • Fax:
Mailing address:
  • Phone: 913-677-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number14-55250-101
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number53-75037-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: