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NPI Code Detail

MEDICARE: AMANDA STICE APRN

MEDICARE: AMANDA STICE APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner76694KS

General Provider Information

NPI Number : 1346631462
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA STICE APRN
Provider Business Mailing Address
First Line : PO BOX 1832
Second Line :
City : PITTSBURG
State : KS
Zip : 66762-1832
Country : US
Telephone Number : 620-231-9873
Fax Number : 620-240-5062
Provider Business Practice Location Address
First Line : 2322 S MAIN ST
Second Line :
City : FORT SCOTT
State : KS
Zip : 66701-3026
Country : US
Telephone Number : 888-777-9170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2015
Last Update Date : 05/01/2023

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