Healthcare Provider Details

I. General information

NPI: 1427867795
Provider Name (Legal Business Name): AMY QUALLS PHD, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E PLEASURE AVE STE 4
SEARCY AR
72143-7710
US

IV. Provider business mailing address

404 N SPRUCE ST
SEARCY AR
72143-4231
US

V. Phone/Fax

Practice location:
  • Phone: 870-834-2611
  • Fax:
Mailing address:
  • Phone: 501-238-0267
  • Fax: 844-990-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2699
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86390894
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: