Provider Demographics
NPI:1952695850
Name:GEATER, AMY CAROL
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:CAROL
Last Name:GEATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OLA
Mailing Address - State:AR
Mailing Address - Zip Code:72853-9266
Mailing Address - Country:US
Mailing Address - Phone:479-747-0311
Mailing Address - Fax:
Practice Address - Street 1:10280 HORSESHOE LOOP
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-7746
Practice Address - Country:US
Practice Address - Phone:479-453-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2423596001Medicare PIN