Healthcare Provider Details

I. General information

NPI: 1053737452
Provider Name (Legal Business Name): ELIZABETH THOMASON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SHEPHERD DR
SEARCY AR
72143-6873
US

IV. Provider business mailing address

610 SHEPHERD DR
SEARCY AR
72143-6873
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-6831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA003992
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: