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General NPI Number Information
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NPI Number | 1073877023
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Entity Type | Organization
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Legal Business Name | DIABETIC EXPERTS OF ARKANSAS, LLC
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 905 20TH ST SUITE B
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City | BATESVILLE
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State | AR
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Zip | 72501-7008
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Country | US
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Telephone | 870-569-4942
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 349 SUITE B
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City | ROSIE
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State | AR
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Zip | 72571-0349
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Country | US
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Telephone | 870-569-4942
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Fax |
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Authorized Official
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Title or Position | NURSE PRACITIONER/OWNER
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Name | MRS. RACHEL JEANNETTE JOHNSON
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Credential | RNP
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Telephone | 870-799-4494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | P01429
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License Number State | AR
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