Individual
MS. AMANDA J BLACKMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1100 N SAINT FRANCIS ST, STE 130, WICHITA, KS 67214-2878
(316) 264-3505
(316) 264-0908
Mailing address
1100 N SAINT FRANCIS ST, STE 130, WICHITA, KS 67214-2878
(316) 264-3505
(316) 264-0908
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-01405
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200672080A
—
KS
Enumeration date
08/14/2010
Last updated
02/10/2014
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