Amanda Wallick

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY1141 Issued in NV

Practice address

6787 W Tropicana Ave
Las Vegas, NV 89103-4757

Phone

(702) 659-5400

NPI assigned

May 22, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda Blunk Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Medens Health

  • Clinical Psychologist
  • San Francisco, CA
  • NPI 1003431784
  NPD

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1871150086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6787 W TROPICANA AVE STE 241",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891034759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6787 W TROPICANA AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891034757",
            "telephone_number": "702-659-5400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6900 N Pecos Rd",
            "address_purpose": "LOCATION",
            "city": "North Las Vegas",
            "state": "NV",
            "postal_code": "890864400",
            "country_code": "US",
            "telephone_number": "702-791-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLICK",
        "first_name": "AMANDA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-22",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NV",
            "license": "PY1141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "BLUNK",
            "credential": "AMANDA BLUNK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michelle S. Waller, DNP, APRN, FNP-C
• Mike Waller
• Sandy Lashanna Waller
• Saulesh Waller
• Zachariah Waller
• Cierra Patricia Walling, BCBA
• Katherine Hanta Wallisch, M.S., CCC-SLP
• Andrew Walls, M.D.
• Angela Walls
• Jason Walls

• Clinical Psychologist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Clinical Psychologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.