Healthcare Provider Details

I. General information

NPI: 1710303250
Provider Name (Legal Business Name): AMANDA LEIGH GWIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. AMANDA LEIGH COX

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 500
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-5838
  • Fax: 501-603-1539
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA550
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: