Provider Demographics
NPI:1205142296
Name:DEBBRECHT, AMY (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DEBBRECHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:CHINAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 S. MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:316-962-7188
Mailing Address - Fax:316-962-7199
Practice Address - Street 1:551 N HILLSIDE
Practice Address - Street 2:SUITE 330
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4926
Practice Address - Country:US
Practice Address - Phone:316-962-7188
Practice Address - Fax:316-962-7199
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200671750AMedicaid
KS111066001Medicare PIN