Healthcare Provider Details

I. General information

NPI: 1114914926
Provider Name (Legal Business Name): MARY M STRICKLAND APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH ST SUITE 05H/LR
LITTLE ROCK AR
72205-5446
US

IV. Provider business mailing address

108 ASPEN CV
ARKADELPHIA AR
71923-6654
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-5117
  • Fax: 501-257-5056
Mailing address:
  • Phone: 870-246-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberS01075
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: