Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | C-6136 | AR |
N | 207T00000X | Neurosurgeon | C6136 | AR |
NPI | 1104911759 |
---|---|
Provider Name | Rebecca Barrett-Tuck |
First Address | Jonesboro, AR 72403-1960 |
Second Address | Jonesboro, AR 72401-8413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 14/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114326001 | (05) | AR |
D04430 | (02) |