Healthcare Provider Details

I. General information

NPI: 1841380334
Provider Name (Legal Business Name): AMY MARIE WILSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SAINT VINCENT CIR STE 300
LITTLE ROCK AR
72205-5417
US

IV. Provider business mailing address

PO BOX 649411
DALLAS TX
75264-9411
US

V. Phone/Fax

Practice location:
  • Phone: 501-480-8800
  • Fax: 501-480-8815
Mailing address:
  • Phone: 501-480-8800
  • Fax: 501-480-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberA001902
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: