Healthcare Provider Details

I. General information

NPI: 1629607874
Provider Name (Legal Business Name): AMANDA THOMAS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 N TULLIS AVE STE 300
KANSAS CITY MO
64158-5114
US

IV. Provider business mailing address

8380 N TULLIS AVE STE 300
KANSAS CITY MO
64158-5114
US

V. Phone/Fax

Practice location:
  • Phone: 816-415-3451
  • Fax:
Mailing address:
  • Phone: 816-407-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023014181
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: