Provider Demographics
NPI:1760922058
Name:PHELPS, AMY LANELLE (APRN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LANELLE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CRESTWOOD CIR STE L
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-5512
Mailing Address - Country:US
Mailing Address - Phone:479-243-2103
Mailing Address - Fax:479-243-2243
Practice Address - Street 1:400 CRESTWOOD CIR STE L
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-5512
Practice Address - Country:US
Practice Address - Phone:479-243-2103
Practice Address - Fax:479-243-2243
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005026363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care