Basic Information
| Provider Information | |||||||||
| NPI: | 1164450185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENTON | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 39 | ||||||||
| Address2: | |||||||||
| City: | HUMBOLDT | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667480039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6204732241 | ||||||||
| FaxNumber: | 6204733334 | ||||||||
| Practice Location | |||||||||
| Address1: | 3751 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 673018446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203311748 | ||||||||
| FaxNumber: | 6203311940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 74837 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.