Basic Information
Provider Information | |||||||||
NPI: | 1578708186 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AMEY-PERRIN | ||||||||
FirstName: | VERONICA | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | AMEY | ||||||||
OtherFirstName: | VERONICA | ||||||||
OtherMiddleName: | LYNN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1600 N LORRAINE ST STE 202 | ||||||||
Address2: |   | ||||||||
City: | HUTCHINSON | ||||||||
State: | KS | ||||||||
PostalCode: | 675015600 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6206637595 | ||||||||
FaxNumber: | 6205135098 | ||||||||
Practice Location | |||||||||
Address1: | 1600 N LORRAINE ST STE 202 | ||||||||
Address2: |   | ||||||||
City: | HUTCHINSON | ||||||||
State: | KS | ||||||||
PostalCode: | 67501 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6206657595 | ||||||||
FaxNumber: | 6206635263 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/10/2008 | ||||||||
LastUpdateDate: | 03/25/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/25/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 2017018906 | MO | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 7115 | KS | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 0434205 | KS | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
ID | Type | State | Issuer | Description | 200972360A | 05 | KS |   | MEDICAID | 1578708186 | 05 | MO |   | MEDICAID |