Provider Demographics
NPI:1902138001
Name:CARR, AMY MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:CARR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8629 BLUEJACKET ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1604
Mailing Address - Country:US
Mailing Address - Phone:913-677-0500
Mailing Address - Fax:
Practice Address - Street 1:8629 BLUEJACKET ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1604
Practice Address - Country:US
Practice Address - Phone:913-677-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-55250-101163WP0808X
KS53-75037-101163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1699730846OtherFSS, PPA NPI