Provider Demographics
NPI:1174504641
Name:ELETHORP, PATRICIA LYNN (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:ELETHORP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LYNN
Other - Last Name:ELETHORP GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1196
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:AR
Mailing Address - Zip Code:71744-1196
Mailing Address - Country:US
Mailing Address - Phone:870-798-4064
Mailing Address - Fax:870-798-4100
Practice Address - Street 1:253 SOUTH CONCORD
Practice Address - Street 2:
Practice Address - City:STRONG
Practice Address - State:AR
Practice Address - Zip Code:71765-0565
Practice Address - Country:US
Practice Address - Phone:870-797-7620
Practice Address - Fax:870-798-4100
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR204510003Medicaid
OKH39206Medicare UPIN