MEDICARE: AMANDA LASHEA ALLEN APRN

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	363LF0000X	Family Nurse Practitioner	A006052	AR

General Provider Information

NPI Number	:	1760949713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LASHEA ALLEN APRN

Provider Business Mailing Address
First Line	:	409 N UNIVERSITY AVE
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-3108
Country	:	US
Telephone Number	:	501-664-6980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 SPRINGHILL RD
Second Line	:
City	:	BRYANT
State	:	AR
Zip	:	72019-7552
Country	:	US
Telephone Number	:	501-664-6980
Fax Number	:

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

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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