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NPI Code Detail

MEDICARE: COURTNEY BLAIR EBERHARD

MEDICARE: COURTNEY BLAIR EBERHARD
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner123616AR

General Provider Information

NPI Number : 1962032888
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY BLAIR EBERHARD
Provider Business Mailing Address
First Line : 2255 STURGIS RD
Second Line :
City : CONWAY
State : AR
Zip : 72034-8029
Country : US
Telephone Number : 501-205-0011
Fax Number :
Provider Business Practice Location Address
First Line : 2255 STURGIS RD
Second Line :
City : CONWAY
State : AR
Zip : 72034-8029
Country : US
Telephone Number : 501-205-0011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2020
Last Update Date : 01/20/2020

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Directions to “ COURTNEY BLAIR EBERHARD ” Practice Location

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