Individual
MRS. AMANDA SHAWN WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1629 HARDING BLVD, COTTER, AR 72626-9770
(870) 435-1629
Mailing address
17 S GOLDEN EYE CT, MOUNTAIN HOME, AR 72653-5230
(870) 321-9478
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
902479
MS
363LP2300X
Primary Care Nurse Practitioner
Primary
A005997
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5EA99
BLUE CROSS BLUE SHIELD OF ARKANSAS
AR
Enumeration date
02/15/2018
Last updated
02/24/2026
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