Provider Demographics
NPI:1528226206
Name:KING, AMY MICHELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:KING
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:NUESSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:7331 PLAZA LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2125
Mailing Address - Country:US
Mailing Address - Phone:310-497-6537
Mailing Address - Fax:
Practice Address - Street 1:556 N OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4227
Practice Address - Country:US
Practice Address - Phone:310-497-6537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55701367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200592480AMedicaid
KSP00765672OtherRR MEDICARE GROUP CQ2302
KS110017017Medicare PIN