Provider Demographics
NPI:1790042661
Name:ADAMS, AMANDA JO (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:ADAMS
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 1:2090 W DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6869
Mailing Address - Country:US
Mailing Address - Phone:913-356-8300
Mailing Address - Fax:
Practice Address - Street 1:2090 W DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-6869
Practice Address - Country:US
Practice Address - Phone:913-355-8300
Practice Address - Fax:913-356-8711
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily