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General NPI Number Information
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NPI Number | 1477066264
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Entity Type | Organization
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Legal Business Name | CLAIRE RUSSELL FAMILY MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 300 W COLLIN RAYE DR STE 101B
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City | DE QUEEN
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State | AR
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Zip | 71832-2003
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Country | US
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Telephone | 903-280-2813
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W COLLIN RAYE DR STE 101B
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City | DE QUEEN
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State | AR
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Zip | 71832-2003
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Country | US
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Telephone | 903-280-2813
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KATINA R LEVINGSTON
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Credential |
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Telephone | 903-293-7093
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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 |
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License Number State |
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