Provider Demographics
NPI:1376946152
Name:BINGHAM, ADRIAN N (RN, LAC)
Entity Type:Individual
Prefix:MRS
First Name:ADRIAN
Middle Name:N
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 SANDINO DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-8763
Mailing Address - Country:US
Mailing Address - Phone:501-442-9679
Mailing Address - Fax:
Practice Address - Street 1:1117 SANDINO DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-8763
Practice Address - Country:US
Practice Address - Phone:501-442-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR84437163WC0400X
ARA1602012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management