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NPI Code Detail

MEDICARE: MONIQUE THAMMAVONG APRN, NP-C

MEDICARE: MONIQUE THAMMAVONG APRN, NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerA004175AR

General Provider Information

NPI Number : 1275932253
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONIQUE THAMMAVONG APRN, NP-C
Provider Business Mailing Address
First Line : 11001 EXECUTIVE CENTER DR STE 200
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-4393
Country : US
Telephone Number : 479-474-1100
Fax Number : 479-471-1335
Provider Business Practice Location Address
First Line : 209 POINTER TRL W STE A
Second Line :
City : VAN BUREN
State : AR
Zip : 72956-2238
Country : US
Telephone Number : 479-474-1100
Fax Number : 479-471-1335
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2014
Last Update Date : 10/11/2023

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