Healthcare Provider Details

I. General information

NPI: 1588484257
Provider Name (Legal Business Name): ANGELICA PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W STILLWELL AVE
DE QUEEN AR
71832-2860
US

IV. Provider business mailing address

307 W STILLWELL AVE
DE QUEEN AR
71832-2860
US

V. Phone/Fax

Practice location:
  • Phone: 870-642-4214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number23412970
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: