Provider Demographics
NPI:1396054904
Name:BARTTER, TEKA MARRIE (APN)
Entity type:Individual
Prefix:MRS
First Name:TEKA
Middle Name:MARRIE
Last Name:BARTTER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11712 PLEASANT RIDGE DR
Mailing Address - Street 2:APT. 510
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-2346
Mailing Address - Country:US
Mailing Address - Phone:856-979-2832
Mailing Address - Fax:501-379-9330
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:#555
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-5525
Practice Address - Fax:501-686-7893
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA03175 ANP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184146758Medicaid
AR184146758Medicaid