Provider Demographics
NPI:1881784353
Name:FREDRICH, CECELIA HOPE (APN, DNSC)
Entity type:Individual
Prefix:MS
First Name:CECELIA
Middle Name:HOPE
Last Name:FREDRICH
Suffix:
Gender:F
Credentials:APN, DNSC
Other - Prefix:DR
Other - First Name:HOPE
Other - Middle Name:HARTZ
Other - Last Name:FREDRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN,DNSC
Mailing Address - Street 1:3486 HEARTHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-8631
Mailing Address - Country:US
Mailing Address - Phone:479-751-3070
Mailing Address - Fax:479-751-3070
Practice Address - Street 1:2422 N THOMPSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-1757
Practice Address - Country:US
Practice Address - Phone:479-750-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARANP1014363LG0600X
ARANP01014363LF0000X
ARA01014ANP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121418758Medicaid
AR121418758Medicaid