Provider Demographics
NPI:1265401160
Name:CHITSEY, AMANDA (APN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CHITSEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2458
Mailing Address - Street 2:MOUNTAIN HOME
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-2458
Mailing Address - Country:US
Mailing Address - Phone:870-424-7070
Mailing Address - Fax:870-424-6616
Practice Address - Street 1:6166 HWY 206 WEST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-9235
Practice Address - Country:US
Practice Address - Phone:870-424-7070
Practice Address - Fax:870-424-6616
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01409363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157479758Medicaid
AR500007023OtherRAILROAD #
AR5U437Medicare ID - Type UnspecifiedNURSE PRACTITIONER
AR500007023OtherRAILROAD #