Provider Demographics
NPI:1093717035
Name:GLYNNE, ROSE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:L
Last Name:GLYNNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1000 W KINGSHIGHWAY STE 14
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4197
Mailing Address - Country:US
Mailing Address - Phone:870-239-8591
Mailing Address - Fax:870-239-8137
Practice Address - Street 1:1110 W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4164
Practice Address - Country:US
Practice Address - Phone:870-205-2000
Practice Address - Fax:870-205-2001
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC36353207V00000X
ARE-8911207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36353OtherLICENSE
AR206899001Medicaid
NC89013T3Medicaid
NC89013T3Medicaid