Provider Demographics
NPI:1326595042
Name:GRANT, AMBER KAY (APRN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:KAY
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MEDICAL CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9017
Mailing Address - Country:US
Mailing Address - Phone:316-283-2800
Mailing Address - Fax:316-283-3575
Practice Address - Street 1:1306 STATE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-1126
Practice Address - Country:US
Practice Address - Phone:316-775-9191
Practice Address - Fax:316-775-0348
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77786363LF0000X
KS13-104386-082163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse