Provider Demographics
NPI:1063505147
Name:HISER, CORINNE (ANP)
Entity Type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:
Last Name:HISER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2941
Mailing Address - Country:US
Mailing Address - Phone:870-425-6971
Mailing Address - Fax:870-508-8908
Practice Address - Street 1:630 BURNETT DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2941
Practice Address - Country:US
Practice Address - Phone:870-425-6971
Practice Address - Fax:870-508-8900
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR170141758Medicaid
5U543Medicare ID - Type Unspecified