MEDICARE: NINA E DEAL FNP-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
1	363LF0000X	Family Nurse Practitioner	A005192	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	585952ZHOW	OTHER	AR	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	A005192	OTHER	AR	AR LICENSE

General Provider Information

NPI Number	:	1427578954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA E DEAL FNP-C

Provider Business Mailing Address
First Line	:	2918 LOUIS SESSIONS ST
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-6049
Country	:	US
Telephone Number	:	870-265-5343
Fax Number	:	870-265-5686

Provider Business Practice Location Address
First Line	:	2918 LOUIS SESSIONS ST
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-6049
Country	:	US
Telephone Number	:	870-265-5343
Fax Number	:	870-265-5686

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

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	07/21/2022

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Directions to “ NINA E DEAL FNP-C” Practice Location

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