Provider Demographics
NPI:1154781664
Name:WALD, AMY DIANE (FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:WALD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SW ARBORWALK BLVD # A
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4101
Mailing Address - Country:US
Mailing Address - Phone:816-537-6232
Mailing Address - Fax:816-537-9161
Practice Address - Street 1:1301 SW ARBORWALK BLVD STE A
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4101
Practice Address - Country:US
Practice Address - Phone:816-537-6232
Practice Address - Fax:816-537-9161
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016005843363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily