Rose Archie

Individual provider Active NPI Licensed Practical Nurse · Texarkana, AR

NPI 1104557693 · NPPES record last updated Jun 23, 2022

Key facts

NPI
1104557693
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
L041100 (AR)
Practice address
2511 E 24TH St Apt 1
Texarkana, AR 71854-4058
Phone
(903) 293-1256
NPI assigned
Jun 23, 2022
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
L041100ARMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X L041100 AR Yes

Addresses

Primary practice location

2511 E 24TH St Apt 1
Texarkana, AR 71854-4058

Mailing address

2511 E 24TH St Apt 1
Texarkana, AR 71854-4058
Phone (903) 293-1256

Other providers in Texarkana, AR

All providers in Texarkana, AR · Licensed Practical Nurse in Arkansas

Sources for this page

Verify at the official NPI Registry.