Individual provider Active NPI

Amber Noel Moore, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Wichita, KS
National Provider Identifier
1396447157
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
81850 Issued in KS
Practice address
5315 E 21St St N Ste 108
Wichita, KS 67208-1600
Phone
(316) 285-9168
Fax
(908) 484-9596
NPI assigned
Mar 17, 2023
Last updated
Jan 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 81850 KS Primary

Addresses

Primary practice location

5315 E 21St St N Ste 108
Wichita, KS 67208-1600

Mailing address

5315 E 21St St N Ste 108
Wichita, KS 67208-1600
Phone (620) 382-4206

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
81850KSMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Now Psychiatry LLC Psychiatric/Mental Health CurrentSince Jan 14, 2024 Accepting new patients

Locations

5315 E 21st St N
Ste 108
Wichita, KS 67208
Phone (316) 285-9168

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1396447157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5315 E 21ST ST N STE 108",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672081600",
            "telephone_number": "620-382-4206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5315 E 21ST ST N STE 108",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672081600",
            "telephone_number": "316-285-9168",
            "fax_number": "908-484-9596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "AMBER",
        "middle_name": "NOEL",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-17",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KS",
            "license": "81850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.