Provider Demographics
NPI:1003895541
Name:HARTNESS, BIRTHA V (ANP)
Entity type:Individual
Prefix:
First Name:BIRTHA
Middle Name:V
Last Name:HARTNESS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72529
Mailing Address - Country:US
Mailing Address - Phone:870-257-6060
Mailing Address - Fax:870-257-7664
Practice Address - Street 1:195 HOSPITAL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529
Practice Address - Country:US
Practice Address - Phone:870-257-6060
Practice Address - Fax:870-257-7664
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152967758Medicaid
AR5U647OtherBLUE CROSS BLUE SHEILD
ARAO 1567OtherSTATE LICENSE NUMBER
ARP00134956OtherMEDICARE RAILROAD
AR770016758OtherBREAST CARE PROVIDER #
AR770016758OtherBREAST CARE PROVIDER #
ARMHO781042OtherDEA NUMBER
AR5U647OtherBLUE CROSS BLUE SHEILD