=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386060010
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ANDREW GUINN APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2014
-----------------------------------------------------
Last Update Date | 04/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1906 W HILLSBORO ST
-----------------------------------------------------
City | EL DORADO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71730-6806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-639-9322
-----------------------------------------------------
Fax | 501-492-6477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11898
-----------------------------------------------------
City | EL DORADO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71730-0037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-639-9322
-----------------------------------------------------
Fax | 501-492-6477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | A004048
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------