Healthcare Provider Details

I. General information

NPI: 1487576898
Provider Name (Legal Business Name): AMANDALYN BOEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ELBERTA ST
LAMAR AR
72846-8100
US

IV. Provider business mailing address

301 ELBERTA ST
LAMAR AR
72846-8100
US

V. Phone/Fax

Practice location:
  • Phone: 479-885-3914
  • Fax:
Mailing address:
  • Phone: 479-885-3914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR077601
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: