Provider Demographics
NPI:1447419643
Name:PLUNKETT, AMY LEE (DNP, APN)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LEE
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:DNP, APN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LEE
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2233 N GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2833
Mailing Address - Country:US
Mailing Address - Phone:479-856-6530
Mailing Address - Fax:479-856-6533
Practice Address - Street 1:2233 N GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2833
Practice Address - Country:US
Practice Address - Phone:479-856-6530
Practice Address - Fax:479-856-6533
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01132363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200041850AMedicaid
AR154408758Medicaid
ARQ18019Medicare UPIN
AR154408758Medicaid