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General NPI Number Information
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NPI Number | 1669763868
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Entity Type | Individual
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Provider Name | AMANDA WILCOX M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 719 DETROIT AVE
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City | DANVILLE
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State | AR
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Zip | 72833-9607
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Country | US
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Telephone | 479-495-2241
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Fax |
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Provider Business Mailing Address
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Address Line | 719 DETROIT AVE
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City | DANVILLE
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State | AR
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Zip | 72833-9607
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Country | US
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Telephone | 479-495-2241
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31059
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E20073
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License Number State | AR
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