Basic Information
Provider Information
NPI: 1104087436
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEERY
FirstName: AMY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1897
Address2:  
City: WICHITA
State: KS
PostalCode: 672011897
CountryCode: US
TelephoneNumber: 3162688131
FaxNumber: 3162914788
Practice Location
Address1: 707 N EMPORIA ST
Address2:  
City: WICHITA
State: KS
PostalCode: 672143707
CountryCode: US
TelephoneNumber: 3168583460
FaxNumber: 3168583458
Other Information
ProviderEnumerationDate: 06/19/2008
LastUpdateDate: 06/27/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X04-34957KSY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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