Provider Demographics
NPI:1821301466
Name:RUSSELL, CLAIRE (APRN)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:
Last Name:RUSSELL
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 1:310 COUNTRY RD 1105
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:TX
Mailing Address - Zip Code:75567
Mailing Address - Country:US
Mailing Address - Phone:903-280-2813
Mailing Address - Fax:
Practice Address - Street 1:122 SOUTHERN DR
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-8668
Practice Address - Country:US
Practice Address - Phone:870-898-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-25
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653437363LF0000X
ARA001783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR205407758Medicaid