Provider Demographics
NPI:1356802995
Name:HEARD, PATRICE NICOLE (RN)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:NICOLE
Last Name:HEARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:NICOLE
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:301 W CALHOUN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3508
Mailing Address - Country:US
Mailing Address - Phone:870-234-1597
Mailing Address - Fax:870-234-1791
Practice Address - Street 1:301 W CALHOUN
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3508
Practice Address - Country:US
Practice Address - Phone:870-234-1597
Practice Address - Fax:870-234-1791
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR079822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse