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General NPI Number Information
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NPI Number | 1740087832
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Entity Type | Individual
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Provider Name | JOHN RICK AGRE RN
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Gender | Male
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 1100 N UNIVERSITY AVE STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72207-6360
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Country | US
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Telephone | 888-710-8220
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Fax | 866-573-0761
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Provider Business Mailing Address
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Address Line | PO BOX 1848
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City | MENA
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State | AR
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Zip | 71953-1841
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Country | US
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Telephone | 888-710-8220
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Fax | 866-573-0761
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | P001133
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License Number State | AR
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