Provider Demographics
NPI:1720897705
Name:ELSWICK, AMANDA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:ELSWICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-443-3536
Mailing Address - Fax:479-443-3933
Practice Address - Street 1:688 E MILLSAP RD STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3930
Practice Address - Country:US
Practice Address - Phone:479-443-3536
Practice Address - Fax:479-443-3933
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-1353363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical