Healthcare Provider Details

I. General information

NPI: 1952757254
Provider Name (Legal Business Name): EDWARD C WEMMERUS ARNP, CN-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 07/16/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 ROGERS AVE STE 101
FORT SMITH AR
72903-3121
US

IV. Provider business mailing address

4620 ROGERS AVE STE 101
FORT SMITH AR
72903-3121
US

V. Phone/Fax

Practice location:
  • Phone: 479-384-5380
  • Fax: 479-384-5382
Mailing address:
  • Phone: 479-384-5380
  • Fax: 479-384-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number92961
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number218161
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: