Basic Information
| Provider Information | |||||||||
| NPI: | 1386137826 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 WALL ST | ||||||||
| Address2: | |||||||||
| City: | POTEAU | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749534433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186353566 | ||||||||
| FaxNumber: | 9186353308 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 TOWSON AVE | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729014921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794415005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2018 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 107639 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LP2300X | 107639 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.