Provider Demographics
NPI:1962027847
Name:HAWORTH, AMANDA K (APRN, CNM, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:HAWORTH
Suffix:
Gender:F
Credentials:APRN, CNM, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7348 W 21ST ST N STE 107
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1765
Mailing Address - Country:US
Mailing Address - Phone:316-779-2560
Mailing Address - Fax:316-854-2303
Practice Address - Street 1:7348 W 21ST ST N STE 107
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1765
Practice Address - Country:US
Practice Address - Phone:316-779-2560
Practice Address - Fax:316-854-2303
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78649367A00000X
KS53-82235-012363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife