Healthcare Provider Details

I. General information

NPI: 1164196119
Provider Name (Legal Business Name): ANGELA M FRIERSON PROSTHETIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BITTERCRESS DR
NORTH LITTLE ROCK AR
72117-9779
US

IV. Provider business mailing address

PO BOX 17025
NORTH LITTLE ROCK AR
72117-0025
US

V. Phone/Fax

Practice location:
  • Phone: 501-246-9310
  • Fax:
Mailing address:
  • Phone: 501-200-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: