Provider Demographics
NPI:1467758904
Name:BENNETT, AMY M (APN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
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Mailing Address - Street 1:506 LITTLE CREEK CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-7798
Mailing Address - Country:US
Mailing Address - Phone:501-332-7981
Mailing Address - Fax:501-337-9964
Practice Address - Street 1:1002 SCHNEIDER DR STE 104
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4823
Practice Address - Country:US
Practice Address - Phone:501-332-7981
Practice Address - Fax:501-337-9964
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2016-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARATP000330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185941758Medicaid
AR185941758Medicaid