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General NPI Number Information
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NPI Number | 1821690884
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Entity Type | Individual
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Provider Name | MIKKA ELIZABETH FENLEY APRN
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 130 4TH ST
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City | QUITMAN
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State | AR
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Zip | 72131-9289
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Country | US
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Telephone | 888-602-3647
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Fax | 888-571-3256
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Provider Business Mailing Address
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Address Line | PO BOX 1060
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City | MARSHALL
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State | AR
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Zip | 72650-1060
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Country | US
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Telephone | 501-358-6145
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Fax | 501-504-6642
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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 | 213280
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License Number State | AR
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