Provider Demographics
NPI:1003355447
Name:MAUPIN, LEROY JR (APRN)
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:
Last Name:MAUPIN
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7329
Mailing Address - Country:US
Mailing Address - Phone:870-793-4200
Mailing Address - Fax:870-698-1353
Practice Address - Street 1:407 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7329
Practice Address - Country:US
Practice Address - Phone:870-793-4200
Practice Address - Fax:870-698-1353
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005035363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health