Provider Demographics
NPI:1194807859
Name:DIX, AMY L (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:DIX
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:12208 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2812
Practice Address - Country:US
Practice Address - Phone:913-438-0868
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01040363A00000X
MO2007008536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant