Basic Information
| Provider Information | |||||||||
| NPI: | 1689113813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEDWELL | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19550 E 39TH ST S | ||||||||
| Address2: | STE 410 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163032400 | ||||||||
| FaxNumber: | 8168891584 | ||||||||
| Practice Location | |||||||||
| Address1: | 2790 CLAY EDWARDS DR | ||||||||
| Address2: | STE 600 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165613003 | ||||||||
| FaxNumber: | 8168891584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2017 | ||||||||
| LastUpdateDate: | 04/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 2017003654 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AM0700X | 2017003654 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.