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LIBERTY B NEOH NP

>> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1700395225

Individual Registrant:
 LIBERTY B NEOH NP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
128 DANIEL DR  BOONEVILLE, AR 72927-0128 US
Tel: 479-675-2455  Fax: 479-675-4940

Contact information for business:
2901 S 74TH ST  FORT SMITH, AR 72903-5156 US
Tel: 314-364-7595  Fax: --

Registration Information:
NPI: 1700395225
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
ARA005369

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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