MEDICARE: TINA TURLEY RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	R34647	AR

General Provider Information

NPI Number	:	1487874301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA TURLEY RN, BSN

Provider Business Mailing Address
First Line	:	4600 KOON RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-6821
Country	:	US
Telephone Number	:	501-372-2970
Fax Number	:	888-468-9318

Provider Business Practice Location Address
First Line	:	225 S PULASKI ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-1925
Country	:	US
Telephone Number	:	501-372-2970
Fax Number	:	888-468-9318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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