Healthcare Provider Details

I. General information

NPI: 1255063160
Provider Name (Legal Business Name): AMANDA BREWER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HIGHWAY 64 E
AUGUSTA AR
72006-5150
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-347-2508
  • Fax: 870-347-5556
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220940
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: