NPIMap

Organization Active NPI

Selah Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Piggott, AR
National Provider Identifier
1720734247
Registry record updated May 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
SELAH HEALTH
Practice address
180 S Thornton Ave
Piggott, AR 72454-2731
Phone
(870) 970-3180
Fax
(870) 343-6262
NPI assigned
Feb 23, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda Gail Smallmon, APRNNPI 1447481072
Title
Ceo
Phone
(870) 970-3180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

180 S Thornton Ave
Piggott, AR 72454-2731

Mailing address

PO Box 301
Piggott, AR 72454-0301
Phone (870) 970-3180

Other practice location 1

105C W Wall St
Harrisonville, MO 64701-2355
Phone (870) 970-3180

Other identifiers 3

IdentifierTypeStateIssuer
1447481072OtherAMANDA SMALLMON'S NPI #
1518246438OtherTAMMY TRIPP, LSCW, NPI#
291504758MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220324002295 AR Part B Supplier - Clinic/Group Practice 5395130546 Receives reassigned benefits from 6 practitioners
Practice locations: Piggott, AR
O20240912004229 MO Part B Supplier - Clinic/Group Practice 5395130546 Receives reassigned benefits from 1 practitioner
Practice locations: Harrisonville, MO

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2267882Selah Health180 S Thornton Ave, Piggott, AR 72454Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

180 S Thornton Ave
Piggott, AR 72454
Phone (870) 970-3180

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715385600000",
    "number": "1720734247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 301",
            "city": "PIGGOTT",
            "state": "AR",
            "postal_code": "724540301",
            "telephone_number": "870-970-3180",
            "fax_number": "870-201-9686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 S THORNTON AVE",
            "city": "PIGGOTT",
            "state": "AR",
            "postal_code": "724542731",
            "telephone_number": "870-970-3180",
            "fax_number": "870-343-6262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105C W Wall St",
            "address_purpose": "LOCATION",
            "city": "Harrisonville",
            "state": "MO",
            "postal_code": "647012355",
            "country_code": "US",
            "telephone_number": "870-970-3180",
            "fax_number": "870-343-6208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SELAH HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2024-05-11",
        "certification_date": "2024-05-11",
        "status": "A",
        "authorized_official_last_name": "SMALLMON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "GAIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-970-3180",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMANDA SMALLMON'S NPI #",
            "identifier": "1447481072",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAMMY TRIPP, LSCW, NPI#",
            "identifier": "1518246438",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291504758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Piggott, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.