Healthcare Provider Details

I. General information

NPI: 1033661798
Provider Name (Legal Business Name): AMANDA COPE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 N SPRING ST STE C
HARRISON AR
72601-2913
US

IV. Provider business mailing address

724 N SPRING ST STE C
HARRISON AR
72601-2913
US

V. Phone/Fax

Practice location:
  • Phone: 870-743-2448
  • Fax: 870-741-2449
Mailing address:
  • Phone: 870-743-2448
  • Fax: 870-741-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA004948
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: