Healthcare Provider Details

I. General information

NPI: 1558686402
Provider Name (Legal Business Name): REBECCA POWERS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 HIGHWAY 42
CHERRY VALLEY AR
72324-8674
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-442-2040
  • Fax: 870-442-2042
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03349
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberATP-000260
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: