Healthcare Provider Details

I. General information

NPI: 1093439176
Provider Name (Legal Business Name): AMY LYNN BORNHOFT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BALCOM LN
TRUMANN AR
72472-9502
US

IV. Provider business mailing address

3127 SOUTHWEST DR
JONESBORO AR
72404-8404
US

V. Phone/Fax

Practice location:
  • Phone: 870-418-1000
  • Fax: 877-481-0779
Mailing address:
  • Phone: 870-932-3600
  • Fax: 877-481-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number120634
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: