Provider Demographics
NPI:1710106059
Name:WILLIS, AMANDA LEA (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEA
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEA
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2214 CANTERBURY DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2386
Mailing Address - Country:US
Mailing Address - Phone:785-623-2360
Mailing Address - Fax:785-623-2371
Practice Address - Street 1:1122 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2810
Practice Address - Country:US
Practice Address - Phone:316-866-2000
Practice Address - Fax:316-866-2084
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6053208000000X
KS0534830208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics