Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 123724 | AR |
NPI | 1003449687 |
---|---|
Provider Name | Ms. Amy Mary Elizabeth Daughhetee |
First Address | Jonesboro, AR 72401 |
Second Address | Jonesboro, AR 72401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2020 |
Last Update Date | 21/02/2020 |