Provider Demographics
NPI:1912143280
Name:SIDES, LINDA CASEY (ANP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CASEY
Last Name:SIDES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W COURT STREET
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AR
Mailing Address - Zip Code:72641
Mailing Address - Country:US
Mailing Address - Phone:870-446-2203
Mailing Address - Fax:
Practice Address - Street 1:502 W COURT STREET
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AR
Practice Address - Zip Code:72641
Practice Address - Country:US
Practice Address - Phone:870-446-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02915ANP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health