MEDICARE: MS. AMY WOLF L.AC.

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	171100000X	Acupuncturist	L.AC.075	AR

General Provider Information

NPI Number	:	1639535305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY WOLF L.AC.

Provider Business Mailing Address
First Line	:	2201 S R ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-5727
Country	:	US
Telephone Number	:	682-215-9121
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 FORT ST STE J
Second Line	:
City	:	BARLING
State	:	AR
Zip	:	72923-2045
Country	:	US
Telephone Number	:	479-388-0996
Fax Number	:

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

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	06/01/2026

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