Healthcare Provider Details

I. General information

NPI: 1720505167
Provider Name (Legal Business Name): AMANDA RAE MERINO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2017
Last Update Date: 09/04/2023
Certification Date: 09/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23401 PRAIRIE STAR PKWY STE B-300
LENEXA KS
66227-7268
US

IV. Provider business mailing address

3726 N 153RD TER
BASEHOR KS
66007-3008
US

V. Phone/Fax

Practice location:
  • Phone: 913-677-6319
  • Fax: 913-677-1540
Mailing address:
  • Phone: 913-706-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77832-041
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: