Provider Demographics
NPI:1518459965
Name:MANNING, AMANDA DAWN (MSN, APRN, FNP BC-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:MANNING
Suffix:
Gender:F
Credentials:MSN, APRN, FNP BC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SE MOBERLY LN
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3748
Mailing Address - Country:US
Mailing Address - Phone:479-273-1550
Mailing Address - Fax:
Practice Address - Street 1:2900 SE MOBERLY LN
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-273-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR065088163WG0000X
ARA005672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice