Healthcare Provider Details

I. General information

NPI: 1700035185
Provider Name (Legal Business Name): ANDREA STRATTON RN,CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ARKANSAS BLVD
TEXARKANA AR
71854-2105
US

IV. Provider business mailing address

3352 N FUTRALL DR
FAYETTEVILLE AR
72703-4057
US

V. Phone/Fax

Practice location:
  • Phone: 870-772-2170
  • Fax: 870-772-5056
Mailing address:
  • Phone: 479-521-5868
  • Fax: 479-587-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR54822
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: