=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538546874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN PATRICK RICE APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2015
-----------------------------------------------------
Last Update Date | 12/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2424 W MAIN ST
-----------------------------------------------------
City | RUSSELLVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72801-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-500-5001
-----------------------------------------------------
Fax | 501-500-5008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 497
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72006-0497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-347-2534
-----------------------------------------------------
Fax | 870-301-2092
-----------------------------------------------------
=====================================================
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 | 19870
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 222563
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------