Provider Demographics
NPI:1164824744
Name:BRETTMAN, AMY M (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BRETTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 RENNER ROAD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217
Mailing Address - Country:US
Mailing Address - Phone:913-962-2122
Mailing Address - Fax:913-962-2422
Practice Address - Street 1:7230 RENNER ROAD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217
Practice Address - Country:US
Practice Address - Phone:913-962-2122
Practice Address - Fax:913-962-2422
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01726207RG0100X
KS1501726363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical