Healthcare Provider Details

I. General information

NPI: 1235189986
Provider Name (Legal Business Name): AMY R SIPLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 S LAURA ST
WICHITA KS
67211
US

IV. Provider business mailing address

347 S. LAURA ST.
WICHITA KS
67211-1518
US

V. Phone/Fax

Practice location:
  • Phone: 316-686-7117
  • Fax: 316-686-2679
Mailing address:
  • Phone: 316-686-7117
  • Fax: 316-686-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number44906
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number44906
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: