Provider Demographics
NPI:1497206924
Name:NOUANSAVANE, KHEM (APRN)
Entity Type:Individual
Prefix:
First Name:KHEM
Middle Name:
Last Name:NOUANSAVANE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 ROGERS AVE STE 401A
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4034
Mailing Address - Country:US
Mailing Address - Phone:479-314-4650
Mailing Address - Fax:479-452-9459
Practice Address - Street 1:7001 ROGERS AVE STE 401A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4034
Practice Address - Country:US
Practice Address - Phone:479-314-4650
Practice Address - Fax:479-452-4650
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004913363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care