Healthcare Provider Details

I. General information

NPI: 1285956904
Provider Name (Legal Business Name): AMANDA K. WINFREY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 S PROMENADE BLVD
ROGERS AR
72758-9073
US

IV. Provider business mailing address

2012 S PROMENADE BLVD
ROGERS AR
72758-9073
US

V. Phone/Fax

Practice location:
  • Phone: 479-616-1485
  • Fax: 479-239-0536
Mailing address:
  • Phone: 479-616-1485
  • Fax: 479-239-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1618785
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2006001241
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003469
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: