Provider Demographics
NPI:1982128096
Name:FLEMISTER, MYRA BROOKE (APRN)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:BROOKE
Last Name:FLEMISTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:BROOKE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:DERMOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71638-0509
Mailing Address - Country:US
Mailing Address - Phone:870-538-5414
Mailing Address - Fax:870-538-5412
Practice Address - Street 1:233 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:AR
Practice Address - Zip Code:71663-9230
Practice Address - Country:US
Practice Address - Phone:870-737-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005228363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care