Healthcare Provider Details

I. General information

NPI: 1679734081
Provider Name (Legal Business Name): SHARON PASCHAL PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 EAST 24TH STREET APT 1
TEXARKANA AR
71854
US

IV. Provider business mailing address

2511 E 24TH ST APT 1
TEXARKANA AR
71854-4058
US

V. Phone/Fax

Practice location:
  • Phone: 870-774-0758
  • Fax:
Mailing address:
  • Phone: 870-774-0758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number167719783
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: