Healthcare Provider Details

I. General information

NPI: 1518298876
Provider Name (Legal Business Name): AMANDA RENE CARTER MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 HOLLY STREET
SILOAM SPRINGS AR
72761
US

IV. Provider business mailing address

2400 S. 48TH STREET
SPRINGDALE AR
72762
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-2020
  • Fax: 479-750-8967
Mailing address:
  • Phone: 479-750-2020
  • Fax: 479-750-8967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: