Healthcare Provider Details

I. General information

NPI: 1407006703
Provider Name (Legal Business Name): AMY C TANKERSLEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ROSE ST
SHERIDAN AR
72150-2451
US

IV. Provider business mailing address

201 S ROSE ST
SHERIDAN AR
72150-2451
US

V. Phone/Fax

Practice location:
  • Phone: 870-917-2171
  • Fax: 870-917-2161
Mailing address:
  • Phone: 870-917-2171
  • Fax: 870-917-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6913-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: