Healthcare Provider Details

I. General information

NPI: 1437578747
Provider Name (Legal Business Name): KARA DANIELLE TEDFORD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 HEALTH PARK DR
MENA AR
71953-9072
US

IV. Provider business mailing address

PO BOX 1848
MENA AR
71953-1841
US

V. Phone/Fax

Practice location:
  • Phone: 479-437-3449
  • Fax:
Mailing address:
  • Phone: 479-437-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004009
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: