Healthcare Provider Details

I. General information

NPI: 1205937695
Provider Name (Legal Business Name): TAMRA P WARD APNBC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S MAIN ST SUITE 4
MAMMOTH SPRING AR
72554-7423
US

IV. Provider business mailing address

350 MAIN ST SUITE 4
MAMMOTH SPRING AR
72554-7423
US

V. Phone/Fax

Practice location:
  • Phone: 870-625-3111
  • Fax: 870-625-3118
Mailing address:
  • Phone: 870-625-3111
  • Fax: 870-625-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAO2947
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: