Healthcare Provider Details

I. General information

NPI: 1699662817
Provider Name (Legal Business Name): AMY QUALLS REGISTERED DIETITIAN NUTRITIONIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N SPRUCE ST
SEARCY AR
72143-4231
US

IV. Provider business mailing address

404 N SPRUCE ST
SEARCY AR
72143-4231
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: AMY N QUALLS
Title or Position: EMPLOYEE
Credential: PHD, RD
Phone: 870-834-2611