Healthcare Provider Details

I. General information

NPI: 1023053907
Provider Name (Legal Business Name): LINDA PREBBLE RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SOUTH MAIN STREET
MAMMOTH SPRING AR
72554
US

IV. Provider business mailing address

PO BOX 250
MAMMOTH SPRING AR
72554-0250
US

V. Phone/Fax

Practice location:
  • Phone: 807-625-3228
  • Fax: 870-625-3227
Mailing address:
  • Phone: 870-625-3228
  • Fax: 870-625-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number655175
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010012214
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: