Active NPI
Tracy Nedbalek
- Licensed Practical Nurse
- Sherwood, AR
National Provider Identifier
1205552999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- L035367
- Practice address
- 1540 Country Club Rd
Sherwood, AR 72120-5095 - Phone
- (501) 753-5459
- Fax
- (501) 753-5463
- NPI assigned
- Oct 14, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | L035367 | AR | Primary |
Addresses
Primary practice location
1540 Country Club Rd
Sherwood, AR 72120-5095
Mailing address
1540 Country Club Rd
Sherwood, AR 72120-5095
Phone (501) 753-5459
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L035367 | AR | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kid Success, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rehabilitation Clinic/Center
- Conway, AR
- NPI 1609997311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665705600000",
"number": "1205552999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1540 COUNTRY CLUB RD",
"city": "SHERWOOD",
"state": "AR",
"postal_code": "721205095",
"telephone_number": "501-753-5459",
"fax_number": "501-753-5463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 COUNTRY CLUB RD",
"city": "SHERWOOD",
"state": "AR",
"postal_code": "721205095",
"telephone_number": "501-753-5459",
"fax_number": "501-753-5463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEDBALEK",
"first_name": "TRACY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-14",
"last_updated": "2022-10-14",
"certification_date": "2022-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "AR",
"license": "L035367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sherwood, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.