Healthcare Provider Details

I. General information

NPI: 1740104645
Provider Name (Legal Business Name): JOHNNA CHARNETT WARREN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 TOMMY RATZLAFF AVE
GREEN FOREST AR
72638-2906
US

IV. Provider business mailing address

800 TOMMY RATZLAFF AVE
GREEN FOREST AR
72638-2906
US

V. Phone/Fax

Practice location:
  • Phone: 870-438-5203
  • Fax:
Mailing address:
  • Phone: 870-438-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number215382
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: