MEDICARE: CHRISTAL MARTINDALE ANP

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
1	363LF0000X	Family Nurse Practitioner	A001262	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295759629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTAL MARTINDALE ANP

Provider Business Mailing Address
First Line	:	1610 TIMBER RIDGE PL
Second Line	:
City	:	FORDYCE
State	:	AR
Zip	:	71742-2926
Country	:	US
Telephone Number	:	870-352-8353
Fax Number	:	870-352-8429

Provider Business Practice Location Address
First Line	:	201 N CLIFTON ST
Second Line	:
City	:	FORDYCE
State	:	AR
Zip	:	71742-3026
Country	:	US
Telephone Number	:	870-352-6354
Fax Number	:	870-352-6361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	04/18/2022

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