MEDICARE: MRS. EVELENE GRACE BIBLE DNP FNP-BC

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	363LF0000X	Family Nurse Practitioner	122841	AR

General Provider Information

NPI Number	:	1831780337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EVELENE GRACE BIBLE DNP FNP-BC

Provider Business Mailing Address
First Line	:	6884 MADISON 2340
Second Line	:
City	:	HUNTSVILLE
State	:	AR
Zip	:	72740-8271
Country	:	US
Telephone Number	:	479-738-7241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N MOUNT OLIVE ST STE 1
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-9509
Country	:	US
Telephone Number	:	479-524-8175
Fax Number	:

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

Provider Enumeration Date	:	01/28/2021
Last Update Date	:	02/04/2021

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