Provider Demographics
NPI:1780199901
Name:GOOD, AMBER DANELLE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DANELLE
Last Name:GOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 JAYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67025-9187
Mailing Address - Country:US
Mailing Address - Phone:316-772-3520
Mailing Address - Fax:
Practice Address - Street 1:347 S LAURA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1518
Practice Address - Country:US
Practice Address - Phone:316-686-7117
Practice Address - Fax:316-686-2679
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77864363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201177650BMedicaid