Healthcare Provider Details

I. General information

NPI: 1245666536
Provider Name (Legal Business Name): ERIC HAERTLING APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 23RD ST
BATESVILLE AR
72501-6037
US

IV. Provider business mailing address

987 KYLER RD
BATESVILLE AR
72501-7480
US

V. Phone/Fax

Practice location:
  • Phone: 870-569-4341
  • Fax:
Mailing address:
  • Phone: 870-598-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003929
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA003929
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: