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General NPI Number Information
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NPI Number | 1295158913
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Entity Type | Individual
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Provider Name | AMANDA KATLIN REID PA
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Gender | Female
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 09/14/2025
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Provider Practice Location Address
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Address Line | 3317 N WIMBERLY DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4056
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Country | US
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Telephone | 479-521-2752
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Fax | 479-521-4603
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Provider Business Mailing Address
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Address Line | 12804 RHODEN LN
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City | LOWELL
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State | AR
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Zip | 72745-9198
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Country | US
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Telephone | 417-291-2816
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | PA-993
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-993
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License Number State | AR
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