Healthcare Provider Details

I. General information

NPI: 1881476893
Provider Name (Legal Business Name): AMBERLYN MONIQUE FALDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 CHESTNUT ST
VAN BUREN AR
72956-5321
US

IV. Provider business mailing address

2010 CHESTNUT ST
VAN BUREN AR
72956-5321
US

V. Phone/Fax

Practice location:
  • Phone: 479-471-4600
  • Fax: 479-430-7596
Mailing address:
  • Phone: 479-471-4600
  • Fax: 479-430-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number220147
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: