Healthcare Provider Details

I. General information

NPI: 1871908905
Provider Name (Legal Business Name): MICHELLE LAVERNE HARTSHORN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W VALLEY BLVD
TEHACHAPI CA
93561-2119
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-2530
  • Fax: 661-822-2536
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number219418
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95000823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: