Healthcare Provider Details

I. General information

NPI: 1669181665
Provider Name (Legal Business Name): AMBER WOODS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E CENTERTON BLVD
CENTERTON AR
72719-1225
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 479-795-1301
  • Fax: 479-795-1304
Mailing address:
  • Phone: 314-543-6979
  • Fax: 314-364-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: