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General NPI Number Information
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NPI Number | 1255853107
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Entity Type | Individual
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Provider Name | PATRICIA ANN CASTLEBERRY MSE-ECSE
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 7723 COLONEL GLENN RD
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City | LITTLE ROCK
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State | AR
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Zip | 72204-7503
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Country | US
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Telephone | 501-280-9195
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Fax | 501-664-2488
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Provider Business Mailing Address
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Address Line | 13 LAKE FOREST DR
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City | MAYFLOWER
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State | AR
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Zip | 72106-9568
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Country | US
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Telephone | 501-733-9728
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Fax | 501-664-2488
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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