Healthcare Provider Details

I. General information

NPI: 1255358875
Provider Name (Legal Business Name): AMY ASTEL WALLER APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ASTEL WRAY APRN-BC

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 NE RALPH POWELL RD STE A
LEES SUMMIT MO
64064-2316
US

IV. Provider business mailing address

3601 NE RALPH POWELL RD STE A
LEES SUMMIT MO
64064-2316
US

V. Phone/Fax

Practice location:
  • Phone: 816-836-2200
  • Fax: 816-836-2244
Mailing address:
  • Phone: 816-836-2200
  • Fax: 816-836-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-45679-011
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number136973
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: