Provider Demographics
NPI:1215284971
Name:WOODWORTH, AMANDA CORINNE (FNP-C, WHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CORINNE
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:FNP-C, WHNP-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CORINNE
Other - Last Name:BUKATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:7300 W 110TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2332
Mailing Address - Country:US
Mailing Address - Phone:913-787-3728
Mailing Address - Fax:913-730-5463
Practice Address - Street 1:3601 W 133RD ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-3345
Practice Address - Country:US
Practice Address - Phone:913-787-3728
Practice Address - Fax:913-730-5463
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75953363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health