Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | E9406 | AR |
NPI | 1003250945 |
---|---|
Provider Name | Cassandra Lou Hunter |
First Address | Walnut Ridge, AR 72476-0719 |
Second Address | Walnut Ridge, AR 72476-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 09/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
216524001 | (05) | AR |