=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679202204
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BATTY HEALTHCARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2022
-----------------------------------------------------
Last Update Date | 06/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 134 KISER RD
-----------------------------------------------------
City | DE QUEEN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71832-8606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-584-8873
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 134 KISER RD
-----------------------------------------------------
City | DE QUEEN
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71832-8606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-584-8873
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LADONNA KAY BATTY
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 870-584-8873
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------