Provider Demographics
NPI:1154896116
Name:CARPENTER, AMY CALLAWAY (APRN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CALLAWAY
Last Name:CARPENTER
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 1:13344 METCALF AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2804
Mailing Address - Country:US
Mailing Address - Phone:479-629-4445
Mailing Address - Fax:
Practice Address - Street 1:1201 NW BRIARCLIFF PKWY STE 125
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-1774
Practice Address - Country:US
Practice Address - Phone:913-948-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018036471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner