Healthcare Provider Details

I. General information

NPI: 1447476221
Provider Name (Legal Business Name): AMY LEIGH HORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY LEIGH GAINES

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RUSSELL RD
RUSSELLVILLE AR
72802-4320
US

IV. Provider business mailing address

P.O. DRAWER 2109
RUSSELLVILLE AR
72811-2109
US

V. Phone/Fax

Practice location:
  • Phone: 479-967-2316
  • Fax: 479-967-3639
Mailing address:
  • Phone: 479-967-2322
  • Fax: 479-967-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP3118
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: