Provider Demographics
NPI:1114027059
Name:ARZOUMANIAN, AIMEE (PA)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:ARZOUMANIAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2420
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-2420
Mailing Address - Country:US
Mailing Address - Phone:479-709-7399
Mailing Address - Fax:479-709-7053
Practice Address - Street 1:1001 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4921
Practice Address - Country:US
Practice Address - Phone:479-441-3396
Practice Address - Fax:479-441-4917
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-283363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200233360AMedicaid
AR176746741Medicaid
ARP00370750OtherRAILROAD MEDICARE
ARQ11042Medicare UPIN
OK200233360AMedicaid