Provider Demographics
NPI:1710296363
Name:KEARSEY, PATRICE MARIE (ANP)
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:MARIE
Last Name:KEARSEY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:MARIE
Other - Last Name:SENESAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 BUTTERCUP DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2910
Mailing Address - Country:US
Mailing Address - Phone:870-425-3030
Mailing Address - Fax:870-508-8130
Practice Address - Street 1:405 BUTTERCUP DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2910
Practice Address - Country:US
Practice Address - Phone:870-425-3030
Practice Address - Fax:870-508-8130
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03444ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily