Healthcare Provider Details

I. General information

NPI: 1801939558
Provider Name (Legal Business Name): NELDA FAYE NEW PHD, APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 OAK STREET
CONWAY AR
72032
US

IV. Provider business mailing address

21 WOODBRIDGE DR
CONWAY AR
72034-3613
US

V. Phone/Fax

Practice location:
  • Phone: 501-504-2329
  • Fax: 501-504-2309
Mailing address:
  • Phone: 501-730-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number015886
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01040
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA001040
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: