Healthcare Provider Details

I. General information

NPI: 1548173586
Provider Name (Legal Business Name): ANGELA YVETTE NEVELS ROBERSON APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S FLENNIKEN AVE
EL DORADO AR
71730-5540
US

IV. Provider business mailing address

112 S FLENNIKEN AVE
EL DORADO AR
71730-5540
US

V. Phone/Fax

Practice location:
  • Phone: 870-314-1815
  • Fax:
Mailing address:
  • Phone: 870-314-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number239606
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: