Provider Demographics
NPI:1619545829
Name:GLADDEN, NATHAN A (NP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
Last Name:GLADDEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:ALAN
Other - Last Name:GLADDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:103 WOOD DUCK LN
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-7590
Mailing Address - Country:US
Mailing Address - Phone:870-538-7225
Mailing Address - Fax:
Practice Address - Street 1:103 WOOD DUCK LN
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-7590
Practice Address - Country:US
Practice Address - Phone:870-538-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216314363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily