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General NPI Number Information
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NPI Number | 1659663250
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Entity Type | Individual
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Provider Name | THERESA ANN LYBRAND APN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2011
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 105 FRANKIE LN
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City | WHITE HALL
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State | AR
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Zip | 71602-2685
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Country | US
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Telephone | 870-247-6160
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 N PIERCE ST APT E8
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City | LITTLE ROCK
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State | AR
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Zip | 72207-5368
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Country | US
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Telephone | 501-612-2122
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A03561
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License Number State | AR
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