Healthcare Provider Details

I. General information

NPI: 1881811602
Provider Name (Legal Business Name): AMANDA G WAIT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA G RIDDEN

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 NE MCBAINE DR
LEES SUMMIT MO
64064-7880
US

IV. Provider business mailing address

901 E. 104TH ST MAILSTOP 400N
KANSAS CITY MO
64131-9712
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-5780
  • Fax: 816-251-5781
Mailing address:
  • Phone: 816-502-7104
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS10917
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2011016772
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: