Healthcare Provider Details

I. General information

NPI: 1780076299
Provider Name (Legal Business Name): AMBERLY CURTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2015
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN
ROGERS AR
72758
US

IV. Provider business mailing address

1100 W CUNNINGHAM AVE
ROGERS AR
72758-8446
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3279
  • Fax:
Mailing address:
  • Phone: 870-307-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: