MEDICARE: AMY E KERR LP

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
1	103TB0200X	Cognitive & Behavioral Psychologist	916	KS

General Provider Information

NPI Number	:	1942282454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY E KERR LP

Provider Business Mailing Address
First Line	:	7570 W 21ST ST N
Second Line	:	STE 1026D
City	:	WICHITA
State	:	KS
Zip	:	67205-1734
Country	:	US
Telephone Number	:	316-729-6555
Fax Number	:	316-634-4794

Provider Business Practice Location Address
First Line	:	7570 W 21ST ST N
Second Line	:	STE 1026D
City	:	WICHITA
State	:	KS
Zip	:	67205-1734
Country	:	US
Telephone Number	:	316-729-6555
Fax Number	:	316-634-4794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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