Provider Demographics
NPI:1740142900
Name:COTTER INTEGRATIVE HEALTH AND WELLNESS STUDIO, PLLC
Entity type:Organization
Organization Name:COTTER INTEGRATIVE HEALTH AND WELLNESS STUDIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:870-321-9478
Mailing Address - Street 1:17 S GOLDEN EYE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-5230
Mailing Address - Country:US
Mailing Address - Phone:870-321-9478
Mailing Address - Fax:
Practice Address - Street 1:17 S GOLDEN EYE CT
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-5230
Practice Address - Country:US
Practice Address - Phone:870-321-9478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty