Healthcare Provider Details

I. General information

NPI: 1679968002
Provider Name (Legal Business Name): AMY RIEDER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11661 COLLEGE BLVD
OVERLAND PARK KS
66210-4107
US

IV. Provider business mailing address

11661 COLLEGE BLVD
OVERLAND PARK KS
66210-4107
US

V. Phone/Fax

Practice location:
  • Phone: 913-432-8400
  • Fax: 913-432-8402
Mailing address:
  • Phone: 913-432-8400
  • Fax: 913-432-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number76726
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2015005079
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: