MEDICARE: AMBER RALEY BS

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	171M00000X	Case Manager/Care Coordinator		AR

General Provider Information

NPI Number	:	1548477425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER RALEY BS

Provider Business Mailing Address
First Line	:	6349 HIGHWAY 202 E
Second Line	:
City	:	FLIPPIN
State	:	AR
Zip	:	72634-9768
Country	:	US
Telephone Number	:	870-656-6972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 BRADLEY DR
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-2730
Country	:	US
Telephone Number	:	870-424-4021
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	09/08/2020

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Directions to “ AMBER RALEY BS” Practice Location

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