Provider Demographics
NPI:1982068938
Name:VALENTINE, EASTON SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:EASTON
Middle Name:SCOTT
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7800
Mailing Address - Country:US
Mailing Address - Phone:501-279-9000
Mailing Address - Fax:501-279-9011
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE #100
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7800
Practice Address - Country:US
Practice Address - Phone:501-279-9000
Practice Address - Fax:501-279-9011
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2016-024363A00000X
ARPA-659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant