Healthcare Provider Details

I. General information

NPI: 1073877023
Provider Name (Legal Business Name): DIABETIC EXPERTS OF ARKANSAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 20TH ST SUITE B
BATESVILLE AR
72501-7008
US

IV. Provider business mailing address

PO BOX 349 SUITE B
ROSIE AR
72571-0349
US

V. Phone/Fax

Practice location:
  • Phone: 870-569-4942
  • Fax:
Mailing address:
  • Phone: 870-569-4942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberP01429
License Number StateAR

VIII. Authorized Official

Name: MRS. RACHEL JEANNETTE JOHNSON
Title or Position: NURSE PRACITIONER/OWNER
Credential: RNP
Phone: 870-799-4494