Provider Demographics
NPI:1073877023
Name:DIABETIC EXPERTS OF ARKANSAS, LLC
Entity Type:Organization
Organization Name:DIABETIC EXPERTS OF ARKANSAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:JEANNETTE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RNP
Authorized Official - Phone:870-799-4494
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSIE
Mailing Address - State:AR
Mailing Address - Zip Code:72571-0349
Mailing Address - Country:US
Mailing Address - Phone:870-569-4942
Mailing Address - Fax:
Practice Address - Street 1:905 20TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7008
Practice Address - Country:US
Practice Address - Phone:870-569-4942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP01429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty