Healthcare Provider Details

I. General information

NPI: 1396054904
Provider Name (Legal Business Name): TEKA MARRIE BARTTER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST #555
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

11712 PLEASANT RIDGE DR APT. 510
LITTLE ROCK AR
72223-2346
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-5525
  • Fax: 501-686-7893
Mailing address:
  • Phone: 856-979-2832
  • Fax: 501-379-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA03175 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: