Provider Demographics
NPI:1245937002
Name:ADAMS, BRENT D
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:D
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 N REYNOLDS RD STE 4
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2501
Mailing Address - Country:US
Mailing Address - Phone:702-738-4707
Mailing Address - Fax:
Practice Address - Street 1:2213 N REYNOLDS RD STE 4
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2501
Practice Address - Country:US
Practice Address - Phone:702-738-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL040194164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty