Provider Demographics
NPI:1336512474
Name:FABAH, AMIE
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:FABAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 RAYTOWN TRFY
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3846
Mailing Address - Country:US
Mailing Address - Phone:816-510-4549
Mailing Address - Fax:816-207-0468
Practice Address - Street 1:6227 RAYTOWN TRFY
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3846
Practice Address - Country:US
Practice Address - Phone:816-510-4549
Practice Address - Fax:816-207-0468
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5376885111363LP0808X
MO2015013953363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health