Claire Russell Family Medical Center PLLC
Nurse Practitioner, Family in De Queen, AR. Organization (NPI-2).
NPI number1477066264
StatusActive
Last updated in NPPESNov 15, 2017
Details
- NPI
- 1477066264
- Entity type
- Organization (NPI-2)
- Legal business name
- Claire Russell Family Medical Center PLLC
- Organization subpart
- No
- Enumeration date
- Nov 15, 2017
- Last updated
- Nov 15, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | – | – | Yes |
Practice location
300 W Collin Raye Dr Ste 101bDe Queen, AR 71832-2003
Phone 903-280-2813
Mailing address
300 W Collin Raye Dr Ste 101bDe Queen, AR 71832-2003
Phone 903-280-2813
Authorized official
Katina R Levingston
Manager
9032937093
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