Healthcare Provider Details

I. General information

NPI: 1720734247
Provider Name (Legal Business Name): SELAH HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S THORNTON AVE
PIGGOTT AR
72454-2731
US

IV. Provider business mailing address

PO BOX 301
PIGGOTT AR
72454-0301
US

V. Phone/Fax

Practice location:
  • Phone: 870-970-3180
  • Fax: 870-343-6262
Mailing address:
  • Phone: 870-970-3180
  • Fax: 870-201-9686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GAIL SMALLMON
Title or Position: CEO
Credential: APRN
Phone: 870-970-3180