Provider Demographics
NPI:1336455658
Name:PIPPENGER, AMANDA KAY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:PIPPENGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:PIPPENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2861 CHIP SHOT DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8833
Mailing Address - Country:US
Mailing Address - Phone:630-301-1833
Mailing Address - Fax:
Practice Address - Street 1:1700 E QUARTER RD
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4603
Practice Address - Country:US
Practice Address - Phone:479-238-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily