Provider Demographics
NPI:1184015422
Name:SANDEFUR, ERIN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:SANDEFUR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WHITE DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-9467
Mailing Address - Country:US
Mailing Address - Phone:870-307-8326
Mailing Address - Fax:
Practice Address - Street 1:1301 WHITE DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-9467
Practice Address - Country:US
Practice Address - Phone:870-793-5504
Practice Address - Fax:870-262-3253
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR210465758Medicaid
AR5BA31OtherBCBS