Provider Demographics
NPI:1366648511
Name:WACASTER, PRISCILLA ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:ALICE
Last Name:WACASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RESERVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902
Mailing Address - Country:US
Mailing Address - Phone:501-701-6574
Mailing Address - Fax:501-318-0173
Practice Address - Street 1:105 RESERVE AVENUE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71902
Practice Address - Country:US
Practice Address - Phone:501-701-6574
Practice Address - Fax:501-318-0173
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-8402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine