Active NPI
Amber Wagner, MS-CCC-SLP
- Speech-Language Pathologist
- Nashville, AR
National Provider Identifier
1639722903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4258
- Practice address
- 130 Medical Cir
Nashville, AR 71852-8606 - Phone
- (870) 845-8161
- NPI assigned
- Jul 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 4258 | AR | Primary |
Addresses
Primary practice location
130 Medical Cir
Nashville, AR 71852-8606
Mailing address
1060 Chapel Hill Rd
De Queen, AR 71832-9013
Phone (870) 582-4412
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4258 | AR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658707200000",
"number": "1639722903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1060 CHAPEL HILL RD",
"city": "DE QUEEN",
"state": "AR",
"postal_code": "718329013",
"telephone_number": "870-582-4412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 MEDICAL CIR",
"city": "NASHVILLE",
"state": "AR",
"postal_code": "718528606",
"telephone_number": "870-845-8161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "AMBER",
"credential": "MS-CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-16",
"last_updated": "2022-07-25",
"certification_date": "2022-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "4258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nashville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.