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General NPI Number Information
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NPI Number | 1821301466
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Entity Type | Individual
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Provider Name | CLAIRE RUSSELL APRN
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Gender | Female
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Dates
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Enumeration Date | 07/25/2010
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 122 SOUTHERN DR
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City | ASHDOWN
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State | AR
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Zip | 71822-8668
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Country | US
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Telephone | 870-898-6940
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Fax |
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Provider Business Mailing Address
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Address Line | 310 COUNTRY RD 1105
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City | MAUD
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State | TX
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Zip | 75567
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Country | US
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Telephone | 903-280-2813
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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 | 653437
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A001783
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License Number State | AR
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