Provider Demographics
NPI:1114535838
Name:CANSLER, AMBER MICHELLE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELLE
Last Name:CANSLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MICHELLE
Other - Last Name:GAITHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:36 ROMAINE LN
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-8607
Mailing Address - Country:US
Mailing Address - Phone:870-557-9478
Mailing Address - Fax:
Practice Address - Street 1:637 AR-8
Practice Address - Street 2:
Practice Address - City:AMITY
Practice Address - State:AR
Practice Address - Zip Code:71921
Practice Address - Country:US
Practice Address - Phone:870-356-2912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator