Provider Demographics
NPI:1396447157
Name:MOORE, AMBER NOEL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NOEL
Last Name:MOORE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 E 21ST ST N STE 108
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1600
Mailing Address - Country:US
Mailing Address - Phone:620-382-4206
Mailing Address - Fax:
Practice Address - Street 1:5315 E 21ST ST N STE 108
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1600
Practice Address - Country:US
Practice Address - Phone:316-285-9168
Practice Address - Fax:908-484-9596
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS81850363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health