Basic Information
Provider Information
NPI: 1407230717
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PUNCHES
FirstName: AMY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7108 S KANNER HWY
Address2:  
City: STUART
State: FL
PostalCode: 349977462
CountryCode: US
TelephoneNumber: 8558326727
FaxNumber: 7726759100
Practice Location
Address1: 325 SW FRAZIER AVE
Address2:  
City: TOPEKA
State: KS
PostalCode: 666061963
CountryCode: US
TelephoneNumber: 7852325005
FaxNumber: 8889725038
Other Information
ProviderEnumerationDate: 07/16/2015
LastUpdateDate: 04/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  N    
171M00000X  N Other Service ProvidersCase Manager/Care Coordinator 
103K00000X  Y Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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