Provider Demographics
NPI:1407989809
Name:DEL VALLE, AMANDA K (ARNP-C,FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:DEL VALLE
Suffix:
Gender:F
Credentials:ARNP-C,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W 4TH ST STE 2050
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1333
Mailing Address - Country:US
Mailing Address - Phone:785-505-3636
Mailing Address - Fax:
Practice Address - Street 1:1130 W 4TH ST STE 2050
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1333
Practice Address - Country:US
Practice Address - Phone:785-505-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161515OtherBCBS OF KS INDIVIDUAL #
KS110035OtherBCBS OF KS GROUP #