Provider Demographics
NPI:1912910050
Name:MONEYMAKER, GUSSIE ANNETT (APN)
Entity Type:Individual
Prefix:
First Name:GUSSIE
Middle Name:ANNETT
Last Name:MONEYMAKER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8679
Mailing Address - Country:US
Mailing Address - Phone:501-207-2738
Mailing Address - Fax:501-268-4445
Practice Address - Street 1:112 BRANTLEY RD
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-8315
Practice Address - Country:US
Practice Address - Phone:501-268-6102
Practice Address - Fax:501-268-4445
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01184 ANP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR440109501OtherMEDICAID PRESCRIBER ID