Provider Demographics
NPI:1306996061
Name:RONAN, AMY JEAN (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:RONAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10536 BOND ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2627
Mailing Address - Country:US
Mailing Address - Phone:913-541-3230
Mailing Address - Fax:913-541-3244
Practice Address - Street 1:10600 QUIVIRA RD
Practice Address - Street 2:SUITE 430
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2309
Practice Address - Country:US
Practice Address - Phone:913-541-3230
Practice Address - Fax:913-541-3244
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006144363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-006144OtherIL STATE LIC
KS46208OtherKANSAS LICENSE