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General NPI Number Information
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NPI Number | 1487250775
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Entity Type | Individual
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Provider Name | JOHNATHAN NOBLE ROSE APRN- CNP
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Gender | Male
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 9601 BAPTIST HEALTH DR STE 900
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6331
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Country | US
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Telephone | 501-224-1135
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Fax |
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Provider Business Mailing Address
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Address Line | 9601 BAPTIST HEALTH DR STE 900
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6331
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Country | US
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Telephone | 501-224-1135
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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 | 212622
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License Number State | AR
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