Provider Demographics
NPI:1518155761
Name:COMBS, KATIE E (APN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:E
Last Name:COMBS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2912
Mailing Address - Country:US
Mailing Address - Phone:870-580-0158
Mailing Address - Fax:870-580-0298
Practice Address - Street 1:501 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2912
Practice Address - Country:US
Practice Address - Phone:870-580-0158
Practice Address - Fax:870-580-0298
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA03025OtherADVANCED NURSE PRACTITIONER
ARA03025OtherADVANCED NURSE PRACTITIONER