=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659092740
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROCHELLE MCCUIEN-FRAZIER APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2022
-----------------------------------------------------
Last Update Date | 09/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | BAPTIST HEALTH CENTER FOR CLINICAL RESEARCH 9601 BAPTIST HEALTH DRIVE MED TOWER 1 SUITE 310
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-224-1348
-----------------------------------------------------
Fax | 501-224-1358
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3350 NICKLAUS DRIVE
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-733-6499
-----------------------------------------------------
Fax | 501-224-1358
-----------------------------------------------------
=====================================================
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 | 219353
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------