Provider Demographics
NPI:1295957124
Name:HEALY, AMANDA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:HEALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5525 W 119TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3724
Mailing Address - Country:US
Mailing Address - Phone:913-491-4020
Mailing Address - Fax:913-491-4725
Practice Address - Street 1:5525 W 119TH ST
Practice Address - Street 2:STE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3724
Practice Address - Country:US
Practice Address - Phone:913-491-4020
Practice Address - Fax:913-491-4725
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-34975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty