Healthcare Provider Details

I. General information

NPI: 1780889766
Provider Name (Legal Business Name): AMY L SCOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N NORTHHILLS BLVD STE B
FAYETTEVILLE AR
72703-4424
US

IV. Provider business mailing address

PO BOX 550
LOWELL AR
72745-0550
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-5500
  • Fax: 479-463-5542
Mailing address:
  • Phone: 479-463-7775
  • Fax: 479-463-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE-5895
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: