Healthcare Provider Details

I. General information

NPI: 1497922918
Provider Name (Legal Business Name): TAMARAH LOVE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 W KEISER AVE
OSCEOLA AR
72370-2806
US

IV. Provider business mailing address

4508 STADIUM BLVD
JONESBORO AR
72404-9675
US

V. Phone/Fax

Practice location:
  • Phone: 870-622-0592
  • Fax: 870-622-0782
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR66598
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: