Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AOO5384 | AR |
NPI | 1013415355 |
---|---|
Provider Name | Nicole Garth |
First Address | Dumas, AR 71639-0012 |
Second Address | Dumas, AR 71639-2139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2018 |
Last Update Date | 14/04/2021 |