Healthcare Provider Details

I. General information

NPI: 1508178955
Provider Name (Legal Business Name): CARRIE DARLENE FENDLEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W SOUTH ST STE B
BENTON AR
72015-4235
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-860-7150
  • Fax: 501-860-7166
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003402
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: