Provider Demographics
NPI:1518622042
Name:BARAJAS, CHARLOTTE R (APRN)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:R
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 N COUNTY ROAD 69
Mailing Address - Street 2:
Mailing Address - City:LEACHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72438-9058
Mailing Address - Country:US
Mailing Address - Phone:870-450-0988
Mailing Address - Fax:
Practice Address - Street 1:225 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3111
Practice Address - Country:US
Practice Address - Phone:870-207-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR212858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily