Healthcare Provider Details

I. General information

NPI: 1548770514
Provider Name (Legal Business Name): LARRY RICHARD ARNOLD FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 NORTHRIDGE RD
BALDWYN MS
38824-1173
US

IV. Provider business mailing address

1031 NORTHRIDGE RD
BALDWYN MS
38824-1173
US

V. Phone/Fax

Practice location:
  • Phone: 662-365-9305
  • Fax:
Mailing address:
  • Phone: 662-365-9305
  • Fax: 662-365-9304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902362
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: