Healthcare Provider Details

I. General information

NPI: 1295235331
Provider Name (Legal Business Name): AMANDA SHAWN WHITAKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 HARDING BLVD
COTTER AR
72626-9770
US

IV. Provider business mailing address

17 S GOLDEN EYE CT
MOUNTAIN HOME AR
72653-5230
US

V. Phone/Fax

Practice location:
  • Phone: 870-435-1629
  • Fax:
Mailing address:
  • Phone: 870-321-9478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA005997
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902479
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: