Provider Demographics
NPI:1578118873
Name:VALERIE, ELIZABETH FAYE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAYE
Last Name:VALERIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W MAPLE AVE STE 205A
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5336
Mailing Address - Country:US
Mailing Address - Phone:479-326-9400
Mailing Address - Fax:479-309-9693
Practice Address - Street 1:601 W MAPLE AVE STE 205A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5336
Practice Address - Country:US
Practice Address - Phone:479-326-9400
Practice Address - Fax:479-309-9693
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program