Healthcare Provider Details

I. General information

NPI: 1497903736
Provider Name (Legal Business Name): B. F. RHOADS RN/CWS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 OLD HICKORY DR.
SHIRLEY AR
72153
US

IV. Provider business mailing address

PO BOX 508
SHIRLEY AR
72153-0508
US

V. Phone/Fax

Practice location:
  • Phone: 501-723-8357
  • Fax:
Mailing address:
  • Phone: 501-723-8357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR44436
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number0681
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: