Healthcare Provider Details

I. General information

NPI: 1700110558
Provider Name (Legal Business Name): AMANDA CLARE MCCORKINDALE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-3925
  • Fax: 501-257-2026
Mailing address:
  • Phone: 501-257-3925
  • Fax: 501-257-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number12-03P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: