Provider Demographics
NPI:1881811602
Name:WAIT, AMANDA G (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:WAIT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:G
Other - Last Name:RIDDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 E. 104TH ST
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-9712
Mailing Address - Country:US
Mailing Address - Phone:816-502-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:2737 NE MCBAINE DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-7880
Practice Address - Country:US
Practice Address - Phone:816-251-5780
Practice Address - Fax:816-251-5781
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10917207V00000X
MO2011016772207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO46070012OtherBCBS OF KC
MO598858OtherCOVENTRY HEALTHCARE OF KANSAS
MO746460OtherMISSOURI CARE
MO1881811602Medicaid
MO0904564OtherCIGNA