Healthcare Provider Details

I. General information

NPI: 1407852734
Provider Name (Legal Business Name): AMY BOAST CAHILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 W 40TH AVE STE 300
PINE BLUFF AR
71603-6366
US

IV. Provider business mailing address

PO BOX 2650
PINE BLUFF AR
71613-2650
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-3608
  • Fax: 870-534-4039
Mailing address:
  • Phone: 870-534-3608
  • Fax: 870-534-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE2091
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: