Provider Demographics
NPI:1093101768
Name:MUNDEN, AMANDA LYNNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNNE
Last Name:MUNDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNNE
Other - Last Name:KRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:14617 S BROUGHAM DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2530
Mailing Address - Country:US
Mailing Address - Phone:913-209-2725
Mailing Address - Fax:
Practice Address - Street 1:8200 W 71ST ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-1715
Practice Address - Country:US
Practice Address - Phone:913-549-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015005058363LF0000X
KS76701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily