Provider Demographics
NPI:1275932253
Name:THAMMAVONG, MONIQUE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:THAMMAVONG
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:479-474-1100
Mailing Address - Fax:479-471-1335
Practice Address - Street 1:209 POINTER TRL W STE A
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2238
Practice Address - Country:US
Practice Address - Phone:479-474-1100
Practice Address - Fax:479-471-1335
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily