Healthcare Provider Details

I. General information

NPI: 1770418741
Provider Name (Legal Business Name): AMENDIEN AMBER THOMAS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16003 BURLEIGH CT
LITTLE ROCK AR
72210-5849
US

IV. Provider business mailing address

16003 BURLEIGH CT
LITTLE ROCK AR
72210-5849
US

V. Phone/Fax

Practice location:
  • Phone: 501-772-7397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number212489
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: