Healthcare Provider Details

I. General information

NPI: 1902727662
Provider Name (Legal Business Name): AMY LYNN IVEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E GARY ST
GREENWOOD AR
72936-7014
US

IV. Provider business mailing address

300 E GARY ST
GREENWOOD AR
72936-7014
US

V. Phone/Fax

Practice location:
  • Phone: 479-996-7440
  • Fax:
Mailing address:
  • Phone: 479-996-7440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR66432
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: