Healthcare Provider Details

I. General information

NPI: 1588138267
Provider Name (Legal Business Name): AMBER R ACORD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9755 W STATE HIGHWAY 22
RATCLIFF AR
72951-9000
US

IV. Provider business mailing address

9505 CHAD COLLEY BLVD APT 1403
FORT SMITH AR
72916-5805
US

V. Phone/Fax

Practice location:
  • Phone: 479-431-2050
  • Fax:
Mailing address:
  • Phone: 479-214-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: