Healthcare Provider Details

I. General information

NPI: 1396230876
Provider Name (Legal Business Name): AMY D BROYLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WESTERN AVE STE 304
CONWAY AR
72034-4981
US

IV. Provider business mailing address

1 SWEETBRIAR LN
GREENBRIER AR
72058-9352
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6560
  • Fax:
Mailing address:
  • Phone: 501-450-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA005490
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: