Provider Demographics
NPI:1255853107
Name:CASTLEBERRY, PATRICIA ANN (MSE-ECSE)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:MSE-ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LAKE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MAYFLOWER
Mailing Address - State:AR
Mailing Address - Zip Code:72106-9568
Mailing Address - Country:US
Mailing Address - Phone:501-733-9728
Mailing Address - Fax:501-664-2488
Practice Address - Street 1:7723 COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7503
Practice Address - Country:US
Practice Address - Phone:501-280-9195
Practice Address - Fax:501-664-2488
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist