MEDICARE: MRS. AMANDA LEIGH JOHNSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	217114	AR

General Provider Information

NPI Number	:	1548194020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LEIGH JOHNSON RN

Provider Business Mailing Address
First Line	:	2300 S DIXIELAND RD
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-6277
Country	:	US
Telephone Number	:	479-636-2202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 S DIXIELAND RD
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-6277
Country	:	US
Telephone Number	:	479-636-2202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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