=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801734397
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALESHA LEA ROSE FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2026
-----------------------------------------------------
Last Update Date | 03/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 E CRANDALL AVE STE A
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72601-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-365-0130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 707
-----------------------------------------------------
City | MOUNTAIN HOME
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72654-0707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-424-7070
-----------------------------------------------------
Fax | 870-424-6616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 124634
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------