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General NPI Number Information
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NPI Number | 1386983468
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Entity Type | Individual
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Provider Name | JOSEPH KENT TETIRICK APN
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Gender | Male
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 02/08/2013
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Provider Practice Location Address
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Address Line | 5808 CALLAWAY LN
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City | FORT SMITH
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State | AR
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Zip | 72916-8437
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Country | US
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Telephone | 423-426-3918
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Fax |
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Provider Business Mailing Address
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Address Line | 132 OAK GROVE RD
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City | VAN BUREN
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State | AR
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Zip | 72956-8410
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Country | US
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Telephone | 501-772-0177
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | A003816
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License Number State | AR
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