MEDICARE: MR. TERRY L. TREECE NURSE PRACTITIONER

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	A01271	AR

General Provider Information

NPI Number	:	1437147188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRY L. TREECE NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	5909 MANDAN RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-3044
Country	:	US
Telephone Number	:	501-821-9953
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 W 7TH ST
Second Line	:	112 LR
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5446
Country	:	US
Telephone Number	:	501-257-5421
Fax Number	:

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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