Provider Demographics
NPI:1144880758
Name:KOELLIKER, AMI L (AGNP-C)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:L
Last Name:KOELLIKER
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 520
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3274
Mailing Address - Country:US
Mailing Address - Phone:816-221-6750
Mailing Address - Fax:816-221-2335
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 520
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3274
Practice Address - Country:US
Practice Address - Phone:816-221-6750
Practice Address - Fax:816-221-2335
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2019021301363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program