Healthcare Provider Details

I. General information

NPI: 1336648377
Provider Name (Legal Business Name): AMBER VINING FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10824 SHAWNEE MISSION PKWY
SHAWNEE KS
66203-3512
US

IV. Provider business mailing address

14057 S INVERNESS ST
OLATHE KS
66061-6834
US

V. Phone/Fax

Practice location:
  • Phone: 913-297-7472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019037892
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78041-081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: