Healthcare Provider Details

I. General information

NPI: 1790649879
Provider Name (Legal Business Name): AMBER ENSLEY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

9153 W 133RD ST
OVERLAND PARK KS
66213-4333
US

IV. Provider business mailing address

9153 W 133RD ST
OVERLAND PARK KS
66213-4333
US

V. Phone/Fax

Practice location:
  • Phone: 913-257-5185
  • Fax: 833-340-7117
Mailing address:
  • Phone: 913-257-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-496740
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: