Provider Demographics
NPI:1588668461
Name:MCINTOSH, LINDA CAROL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CAROL
Last Name:MCINTOSH
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:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:501-305-3535
Practice Address - Street 1:406 RODGERS DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7433
Practice Address - Country:US
Practice Address - Phone:501-279-7979
Practice Address - Fax:501-305-3535
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152253758Medicaid
AR5F531Medicare PIN
AR57297Medicare PIN
AR5X708Medicare PIN
AR152253758Medicaid