Provider Demographics
NPI:1952035693
Name:WHITE, AMY (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2263 HIGHWAY 65 N
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-7660
Mailing Address - Country:US
Mailing Address - Phone:870-448-5733
Mailing Address - Fax:
Practice Address - Street 1:2263 HIGHWAY 65 N
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-7660
Practice Address - Country:US
Practice Address - Phone:870-448-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221172363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health