Amanda Wilson, RN

Primary specialty

Nutrition Support Registered NurseTaxonomy code 163WN1003X

License

R090453 Issued in AR

Practice address

229 N Block Ave
Fayetteville, AR 72701-5204

Phone

(479) 200-2749

NPI assigned

Jun 21, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1718928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1962246207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 N TOWER CIR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727047402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "229 N BLOCK AVE",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727015204",
            "telephone_number": "479-200-2749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AMANDA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-21",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WN1003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nutrition Support",
            "state": "AR",
            "license": "R090453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kara Nicole Willis, LCSW
• Katie Willis
• Joseph Willmuth
• Morgan E Willoughby
• Catherine Kelley Wilmoth, RD,LD
• Kelly Kendra Wilson, LCSW
• Kendra Solon Wilson, PHARMD
• Kristin Noelle Wilson, OTR/L
• Megan Landry Wilson, PT
• Michael R Wilson, M.D.

• Registered Nurse in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Registered Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.