Facts
- Status
- A
- Credential
- APRN
- Type
- Individual
- Enumeration date
- 2021-08-19
- Last updated
- 2021-09-13
Specialties
Licenses
- License AR
- 213430
Location
- Practice location
- 1110 W KINGSHIGHWAY
- City
- PARAGOULD AR
- Postal code
- 724504164
- Phone
- 870-205-2000
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.