Healthcare Provider Details

I. General information

NPI: 1649384413
Provider Name (Legal Business Name): JANET R. CANADA ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 W. E. KNIGHT DRIVE
FORT SMITH AR
72903-6248
US

IV. Provider business mailing address

5401 ELLSWORTH ROAD
FORT SMITH AR
72903-3219
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-6700
  • Fax: 479-709-6768
Mailing address:
  • Phone: 479-314-1101
  • Fax: 479-314-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA02916ANP
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA02916 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: