Healthcare Provider Details

I. General information

NPI: 1447481072
Provider Name (Legal Business Name): AMANDA GAIL SMALLMON APRN, FNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S THORNTON AVE
PIGGOTT AR
72454-2731
US

IV. Provider business mailing address

180 S THORNTON AVE
PIGGOTT AR
72454-2731
US

V. Phone/Fax

Practice location:
  • Phone: 870-970-3180
  • Fax: 870-201-9686
Mailing address:
  • Phone: 870-970-3180
  • Fax: 870-201-9686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberA003277
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2001008943
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000027580
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03277
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27580
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022003488
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA03277
License Number StateAR
# 8
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA003277
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: