Healthcare Provider Details

I. General information

NPI: 1831363654
Provider Name (Legal Business Name): AMANDA K. ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA K. MERRICK MD

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SPRINGHILL ROAD STE 200
BENTON AR
72019
US

IV. Provider business mailing address

2301 SPRINGHILL ROAD SUITE 200
BENTON AR
72019
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-0078
  • Fax: 501-943-3016
Mailing address:
  • Phone: 501-315-0078
  • Fax: 501-943-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-6791
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: