Healthcare Provider Details

I. General information

NPI: 1518933167
Provider Name (Legal Business Name): HERSHEL LYNN MAYO APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W SHERMAN AVE SUITE G
HARRISON AR
72601-2743
US

IV. Provider business mailing address

PO BOX 1597
HARRISON AR
72602-1597
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8247
  • Fax: 870-741-3933
Mailing address:
  • Phone: 870-741-8247
  • Fax: 870-741-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01349
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: