Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 763022 | TX |
N | 363LN0000X | Nurse Practitioner - Neonatal | AO3420 | AR |
NPI | 1083924369 |
---|---|
Provider Name | Patti Renee James |
First Address | Fayetteville, AR 72704-6978 |
Second Address | Fayetteville, AR 72704-6978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2010 |
Last Update Date | 20/10/2010 |