Active NPI
Amanda Autumn Kinnie, M.A.ED, CAGS
- School Psychologist
- Goodyear, AZ
National Provider Identifier
1780494310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 3442757
- Practice address
- 4500 N 155TH Ave
Goodyear, AZ 85395-8397 - Phone
- (623) 570-3876
- NPI assigned
- Jan 7, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 3442757 | AZ | Primary |
Addresses
Primary practice location
4500 N 155TH Ave
Goodyear, AZ 85395-8397
Mailing address
4500 N 155TH Ave
Goodyear, AZ 85395-8397
Phone (623) 570-3876
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
| License | State | Type | Specialty |
|---|---|---|---|
| 3442757 | AZ | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736208000000",
"number": "1780494310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 N 155TH AVE",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853958397",
"telephone_number": "623-570-3876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 N 155TH AVE",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853958397",
"telephone_number": "623-570-3876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINNIE",
"first_name": "AMANDA",
"middle_name": "AUTUMN",
"credential": "M.A.ED, CAGS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-01-07",
"last_updated": "2025-01-07",
"certification_date": "2025-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "AZ",
"license": "3442757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.