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NPI Code Detail

MEDICARE: SAMNIENG M HERNANDEZ APN

MEDICARE: SAMNIENG M HERNANDEZ APN
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
1163WP0808XPsychiatric/Mental Health Registered NurseR68707AR
2363LF0000XFamily Nurse PractitionerA003015AR

Other Identifiers

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

General Provider Information

NPI Number : 1821189879
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMNIENG M HERNANDEZ APN
Provider Business Mailing Address
First Line : PO BOX 700
Second Line :
City : DARDANELLE
State : AR
Zip : 72834-0700
Country : US
Telephone Number : 479-229-8000
Fax Number : 479-477-3927
Provider Business Practice Location Address
First Line : 1652 STATE HIGHWAY 22 W
Second Line :
City : DARDANELLE
State : AR
Zip : 72834-2909
Country : US
Telephone Number : 479-229-8000
Fax Number : 479-477-3927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2006
Last Update Date : 02/03/2016

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Directions to “ SAMNIENG M HERNANDEZ APN” Practice Location

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