Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | A003683 | AR |
NPI | 1003182387 |
---|---|
Provider Name | Mr. Joseph C Fendley |
First Address | Hot Springs, AR 71903-1850 |
Second Address | Hot Springs, AR 71913-7949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2012 |
Last Update Date | 01/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
195151758 | (05) | AR |