Basic Information
| Provider Information | |||||||||
| NPI: | 1447808837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAGNESS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, LSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 43 | ||||||||
| Address2: | |||||||||
| City: | EVENING SHADE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725320043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703073876 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 805 THIRD ST | ||||||||
| Address2: | |||||||||
| City: | HORSESHOE BEND | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725123736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706704861 | ||||||||
| FaxNumber: | 8706704751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2019 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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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 | 163WD0400X | R102939 | AR | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.