Provider Demographics
NPI:1376711937
Name:BRASWELL, FREDERICK (ANP)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:BRASWELL
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 JFK
Mailing Address - Street 2:# 3605
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6766
Mailing Address - Country:US
Mailing Address - Phone:501-663-5221
Mailing Address - Fax:501-663-6759
Practice Address - Street 1:6209 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1505
Practice Address - Country:US
Practice Address - Phone:501-663-5221
Practice Address - Fax:501-663-6759
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03067 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARMB1712846OtherDEA