Provider Demographics
NPI:1366508780
Name:GRIFFETH, SUSAN KATHERINE (ACNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KATHERINE
Last Name:GRIFFETH
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KATHERINE
Other - Last Name:NOTTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9501 BAPTIST HEALTH DR STE 600
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6231
Mailing Address - Country:US
Mailing Address - Phone:501-227-7596
Mailing Address - Fax:501-219-8633
Practice Address - Street 1:9501 BAPTIST HEALTH DR STE 600
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6231
Practice Address - Country:US
Practice Address - Phone:501-227-7596
Practice Address - Fax:501-219-8633
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN131706363LA2100X
MO2008019966363LA2100X
ARA004488363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134554AMedicaid
Q00038Medicare UPIN
GA003134554AMedicaid
GA202I503740Medicare PIN