Healthcare Provider Details

I. General information

NPI: 1588296586
Provider Name (Legal Business Name): AMANDA M HORNE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MAIN ST STE 2A
HARRISON AR
72601-2911
US

IV. Provider business mailing address

620 N MAIN ST STE 2A
HARRISON AR
72601-2911
US

V. Phone/Fax

Practice location:
  • Phone: 870-414-4599
  • Fax: 704-144-4318
Mailing address:
  • Phone: 870-414-4599
  • Fax: 704-144-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number122610
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: