Healthcare Provider Details

I. General information

NPI: 1609341908
Provider Name (Legal Business Name): SANDRA SIDONIA ARNOLD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HIGHLAND COLONY PKWY STE 5203
RIDGELAND MS
39157-2079
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 855-498-6767
  • Fax: 479-968-1673
Mailing address:
  • Phone: 855-498-6767
  • Fax: 479-968-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903943
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019383
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: