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General NPI Number Information
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NPI Number | 1295071322
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Entity Type | Organization
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Legal Business Name | COURTNEY BICKERSTAFF APN,PLLC
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Dates
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Enumeration Date | 12/18/2012
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 1309 ASHLEA PLACE DR
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City | BRYANT
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State | AR
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Zip | 72022-9159
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Country | US
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Telephone | 501-909-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 ASHLEA PLACE DR
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City | BRYANT
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State | AR
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Zip | 72022-9159
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Country | US
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Telephone | 501-909-1153
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Fax |
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Authorized Official
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Title or Position | APN
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Name | COURTNEY CAMILLE BICKERSTAFF
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Credential | APN
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Telephone | 501-909-1153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | A03082
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License Number State | AR
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