Provider Demographics
NPI:1336512474
Name:FABAH, AMIE
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:FABAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12641 ANTIOCH RD STE 1053
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-7352
Mailing Address - Country:US
Mailing Address - Phone:816-510-4549
Mailing Address - Fax:
Practice Address - Street 1:710 N 7TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-3051
Practice Address - Country:US
Practice Address - Phone:913-573-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76885363LF0000X
KS5376885111363LP2300X
MO2015013953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care