Provider Demographics
NPI:1447481072
Name:SMALLMON, AMANDA GAIL (APRN, FNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:SMALLMON
Suffix:
Gender:F
Credentials:APRN, FNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-2731
Mailing Address - Country:US
Mailing Address - Phone:870-970-3180
Mailing Address - Fax:870-201-9686
Practice Address - Street 1:180 S THORNTON AVE
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2731
Practice Address - Country:US
Practice Address - Phone:870-970-3180
Practice Address - Fax:870-201-9686
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003277163WW0000X, 363LP0808X
MO2001008943363LF0000X
TNAPN0000027580363LF0000X
ARA03277363LF0000X, 363LP0808X
TN27580363LP0808X
MO2022003488363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180257758Medicaid