Healthcare Provider Details

I. General information

NPI: 1083192058
Provider Name (Legal Business Name): LATRICIA MEYER QBHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W 3RD ST
IMBODEN AR
72434-9099
US

IV. Provider business mailing address

609 W 3RD ST
IMBODEN AR
72434-9099
US

V. Phone/Fax

Practice location:
  • Phone: 870-869-1500
  • Fax: 870-869-1505
Mailing address:
  • Phone: 870-869-1500
  • Fax: 870-869-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: