Healthcare Provider Details

I. General information

NPI: 1679738538
Provider Name (Legal Business Name): NEPHERTITI EFEOVBOKHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 E JOHNSON AVE
JONESBORO AR
72401-8413
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-934-3630
Mailing address:
  • Phone: 870-936-8000
  • Fax: 870-934-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME124080
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE-8188
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: