Provider Demographics
NPI:1164125795
Name:MARTIN, RODNEYSHA (PA)
Entity Type:Individual
Prefix:
First Name:RODNEYSHA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2121
Mailing Address - Country:US
Mailing Address - Phone:870-594-6001
Mailing Address - Fax:501-823-3623
Practice Address - Street 1:1220 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2121
Practice Address - Country:US
Practice Address - Phone:870-594-6001
Practice Address - Fax:501-823-3623
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical