Healthcare Provider Details

I. General information

NPI: 1619470903
Provider Name (Legal Business Name): FREDRIC L FREDLUND APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N CHESTNUT ST
HARRISON AR
72601-4453
US

IV. Provider business mailing address

PO BOX 1497
HARRISON AR
72602-1497
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8559
  • Fax: 870-741-1798
Mailing address:
  • Phone: 870-741-8559
  • Fax: 870-741-1798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005568
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: