Provider Demographics
NPI:1306033279
Name:SUPT OF OZARK SCHOOL DISTRICT NO 14
Entity Type:Organization
Organization Name:SUPT OF OZARK SCHOOL DISTRICT NO 14
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTORFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:479-468-3440
Mailing Address - Street 1:1609 WALDRON ROAD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949
Mailing Address - Country:US
Mailing Address - Phone:479-468-3440
Mailing Address - Fax:479-468-2135
Practice Address - Street 1:525 HENDRIX ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:AR
Practice Address - Zip Code:72821
Practice Address - Country:US
Practice Address - Phone:479-468-3440
Practice Address - Fax:479-468-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)