Healthcare Provider Details

I. General information

NPI: 1255989588
Provider Name (Legal Business Name): AMANDA MARIE AUSTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NORTH EDMONDS 801 NORTH EDMONDS
MCCRORY AR
72101
US

IV. Provider business mailing address

PO BOX 544
MC CRORY AR
72101-0544
US

V. Phone/Fax

Practice location:
  • Phone: 870-731-5411
  • Fax: 870-731-5431
Mailing address:
  • Phone: 870-318-6592
  • Fax: 870-731-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR100066
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: