Healthcare Provider Details

I. General information

NPI: 1215095211
Provider Name (Legal Business Name): AMY ELIZABETH FLAHERTY LPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 ELM ST
MARKED TREE AR
72365-2330
US

IV. Provider business mailing address

1130 ELM ST
MARKED TREE AR
72365-2330
US

V. Phone/Fax

Practice location:
  • Phone: 870-761-4673
  • Fax:
Mailing address:
  • Phone: 501-514-4709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number06-10E
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: