Healthcare Provider Details

I. General information

NPI: 1467927764
Provider Name (Legal Business Name): AMANDA MARY KLENDA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MEDICAL CENTER DR
NEWTON KS
67114-8780
US

IV. Provider business mailing address

12068 E BRENTMOOR LN
WICHITA KS
67206-2867
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-2700
  • Fax:
Mailing address:
  • Phone: 607-759-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number15-02911
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: