=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427867795
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY QUALLS PHD, RD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2025
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E PLEASURE AVE STE 4
-----------------------------------------------------
City | SEARCY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72143-7710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-834-2611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 N SPRUCE ST
-----------------------------------------------------
City | SEARCY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72143-4231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-238-0267
-----------------------------------------------------
Fax | 844-990-4180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 2699
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 86390894
-----------------------------------------------------
License Number State |
-----------------------------------------------------