1861770828 NPI number — AMY HAM NUNNELEE CCC-A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861770828 NPI number — AMY HAM NUNNELEE CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NUNNELEE
Provider First Name:
AMY
Provider Middle Name:
HAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAM
Provider Other First Name:
AMY
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861770828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4604 W 65TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRAIRIE VLG
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66208-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-651-5448
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20375 W 151ST ST STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66061-5353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-312-1774
Provider Business Practice Location Address Fax Number:
913-764-7502
Provider Enumeration Date:
07/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231HA2500X , with the licence number:  2011019423 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231HA2500X , with the licence number: 1948 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1948 . This is a "AUDIOLOGY LICENSE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 2011019423 . This is a "AUDIOLOGY LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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