Healthcare Provider Details

I. General information

NPI: 1790540540
Provider Name (Legal Business Name): CARTER LEE NORMAN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SCHOOL DR
BRYANT AR
72022-3069
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-361-9822
  • Fax: 501-361-9824
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-301-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number227715
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: