Healthcare Provider Details

I. General information

NPI: 1447419643
Provider Name (Legal Business Name): AMY LEE PLUNKETT DNP, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LEE GLENN

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 N GREEN ACRES RD
FAYETTEVILLE AR
72703-2833
US

IV. Provider business mailing address

2233 N GREEN ACRES RD
FAYETTEVILLE AR
72703-2833
US

V. Phone/Fax

Practice location:
  • Phone: 479-856-6530
  • Fax: 479-856-6533
Mailing address:
  • Phone: 479-856-6530
  • Fax: 479-856-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberA01132
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01132
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: