Provider Demographics
NPI:1497419774
Name:TOUSANT, ROMONDA (APRN)
Entity Type:Individual
Prefix:
First Name:ROMONDA
Middle Name:
Last Name:TOUSANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ROMONDA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13823 HAROLD DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-7293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13823 HAROLD DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-7293
Practice Address - Country:US
Practice Address - Phone:501-838-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR080980363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2022039078OtherMISSOURI APRN LICENSE (PMHNP)
AR217980OtherARKANSAS APRN LICENSE (PMHNP)
ARR080980OtherARKANSAS RN LICENSE (MULTI-STATE)