Healthcare Provider Details

I. General information

NPI: 1326918566
Provider Name (Legal Business Name): AMANDA GALE GARRETSON APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 W 6TH ST
WALDRON AR
72958-7642
US

IV. Provider business mailing address

1331 W 6TH ST
WALDRON AR
72958-7642
US

V. Phone/Fax

Practice location:
  • Phone: 479-637-2136
  • Fax:
Mailing address:
  • Phone: 479-637-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235145
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: