Healthcare Provider Details

I. General information

NPI: 1477757193
Provider Name (Legal Business Name): LINDA GRIGGS ASN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W 3RD ST
FORDYCE AR
71742-3014
US

IV. Provider business mailing address

1101 W 3RD ST
FORDYCE AR
71742-3014
US

V. Phone/Fax

Practice location:
  • Phone: 870-352-5122
  • Fax: 870-352-5127
Mailing address:
  • Phone: 870-352-5122
  • Fax: 870-352-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberR34665
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: