Provider Demographics
NPI:1346924073
Name:BAGGETT, NATHANIEL (OD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:BAGGETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:BROOKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72417-0571
Mailing Address - Country:US
Mailing Address - Phone:870-761-6919
Mailing Address - Fax:
Practice Address - Street 1:2100 E HIGHLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5144
Practice Address - Country:US
Practice Address - Phone:870-972-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist