Provider Demographics
NPI:1902083454
Name:BROOKSHIRE, AMY DAVIS (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DAVIS
Last Name:BROOKSHIRE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:CHRISTINA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:225 SE CITATION ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4121
Mailing Address - Country:US
Mailing Address - Phone:816-468-0320
Mailing Address - Fax:
Practice Address - Street 1:4401 WORNALL ROAD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111
Practice Address - Country:US
Practice Address - Phone:816-932-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150219163WN0002X, 363LN0000X
KS46219363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care