Provider Demographics
NPI:1073363164
Name:CARMEN, ROSSLYN LEANNE
Entity Type:Individual
Prefix:
First Name:ROSSLYN
Middle Name:LEANNE
Last Name:CARMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 FERRELL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-2823
Mailing Address - Country:US
Mailing Address - Phone:501-297-0109
Mailing Address - Fax:
Practice Address - Street 1:3405 N 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-1809
Practice Address - Country:US
Practice Address - Phone:501-297-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR014222801602374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide