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General NPI Number Information
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NPI Number | 1376988378
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Entity Type | Individual
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Provider Name | AMY LEIGH STARK MD
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Gender | Female
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 1400 WALLACE BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1708
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Country | US
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Telephone | 806-414-9970
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Fax | 806-351-3783
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Provider Business Mailing Address
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Address Line | 1400 WALLACE BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1708
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Country | US
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Telephone | 806-414-9970
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Fax | 806-351-3783
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | R7906
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 58205
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | R7906
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R7906
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License Number State | TX
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