Healthcare Provider Details

I. General information

NPI: 1265794564
Provider Name (Legal Business Name): HEATHER LEANN GLOVER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER LEANN HUTTON

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9146 HIGHWAY 63 N
BONO AR
72416
US

IV. Provider business mailing address

9146 HIGHWAY 63 N
BONO AR
72416-8153
US

V. Phone/Fax

Practice location:
  • Phone: 870-930-9990
  • Fax: 870-930-9992
Mailing address:
  • Phone: 870-930-9990
  • Fax: 870-930-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003298
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03298 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: