Individual
AMY MIDCAP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1310 BRADLEY DR, MOUNTAIN HOME, AR 72653-2730
(870) 424-4021
Mailing address
1310 BRADLEY DR, MOUNTAIN HOME, AR 72653-2730
(870) 424-4021
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106500000X
LINELEAD/RBT
AR
Enumeration date
06/01/2022
Last updated
06/01/2022
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