Provider Demographics
NPI:1235651563
Name:MCINTOSH, JOSHUA (APRN)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 VIRGINIA DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7317
Mailing Address - Country:US
Mailing Address - Phone:870-793-2371
Mailing Address - Fax:
Practice Address - Street 1:501 VIRGINIA DR STE C
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7317
Practice Address - Country:US
Practice Address - Phone:870-793-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner