Provider Demographics
NPI:1659663250
Name:LYBRAND, THERESA ANN (APN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:LYBRAND
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:
Other - Last Name:LYBRAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:1402 N PIERCE ST APT E8
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5368
Mailing Address - Country:US
Mailing Address - Phone:501-612-2122
Mailing Address - Fax:
Practice Address - Street 1:105 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2685
Practice Address - Country:US
Practice Address - Phone:870-247-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily