Provider Demographics
NPI:1992024491
Name:MYERS, SUSAN RAE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RAE
Last Name:MYERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 S PINNACLE HILLS PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9016
Mailing Address - Country:US
Mailing Address - Phone:479-338-4000
Mailing Address - Fax:479-338-4050
Practice Address - Street 1:3333 S PINNACLE HILLS PKWY STE 600
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9016
Practice Address - Country:US
Practice Address - Phone:479-338-4000
Practice Address - Fax:479-338-4050
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222186363LW0102X, 363L00000X
MO2010014311367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife