Healthcare Provider Details

I. General information

NPI: 1548998511
Provider Name (Legal Business Name): DORIS JEAN NOBLE ALZHEIMER'S CERT.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 TANGLEWOOD DR
JONESBORO AR
72401-4645
US

IV. Provider business mailing address

1614 TANGLEWOOD DR
JONESBORO AR
72401-4645
US

V. Phone/Fax

Practice location:
  • Phone: 870-713-0633
  • Fax:
Mailing address:
  • Phone: 870-713-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: