Healthcare Provider Details

I. General information

NPI: 1700522422
Provider Name (Legal Business Name): AMANDA STEEN FNP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 11/11/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E MAIN ST
MARSHALL AR
72650-7702
US

IV. Provider business mailing address

403 E MAIN ST
MARSHALL AR
72650-7702
US

V. Phone/Fax

Practice location:
  • Phone: 870-504-2944
  • Fax:
Mailing address:
  • Phone: 870-448-4489
  • Fax: 870-448-4894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LANE STEEN
Title or Position: PRESIDENT
Credential: CNP
Phone: 870-448-4489