Healthcare Provider Details

I. General information

NPI: 1184047730
Provider Name (Legal Business Name): TODD CHRISTOPHER ANDERSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 03/07/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 JACKSON STREET
CABOT AR
72023-3058
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-941-3522
  • Fax: 501-941-3525
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberATP-000613
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004077
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: