Provider Demographics
NPI:1023053907
Name:PREBBLE, LINDA (RN, FNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:PREBBLE
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-0250
Mailing Address - Country:US
Mailing Address - Phone:870-625-3228
Mailing Address - Fax:870-625-3227
Practice Address - Street 1:260 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554
Practice Address - Country:US
Practice Address - Phone:807-625-3228
Practice Address - Fax:870-625-3227
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX655175363L00000X
MO2010012214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1023053907Medicaid
431560263OtherTRICARE WEST
TX8D7099Medicare ID - Type Unspecified
MO132300128Medicare PIN