Theodora L Short, ADVANCED PRACTICE NU
Individual provider Active NPI Nurse Practitioner · Ratcliff, AR
NPI 1295706182 · NPPES record last updated Oct 2, 2007
Key facts
- NPI
- 1295706182
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- A01027 (AR)
- Practice address
- 9755 W. State Highway 22
Ratcliff, AR 72951-9000 - Phone
- (479) 635-5300
- Fax
- (479) 635-2010
- NPI assigned
- Jan 30, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A01027 | AR | MD | Women's Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Andre J. Nolewajka, MD, PA | Nurse Practitioner | Past | Accepting new patients |
| Cooper Clinic PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | A01027 | AR | Yes |
Addresses
Primary practice location
9755 W. State Highway 22
Ratcliff, AR 72951-9000
Mailing address
PO Box 130
Ratcliff, AR 72951-0130
Phone (479) 635-5300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A004 | Other | TRICARE |
Other providers in Ratcliff, AR
- River Valley Primary Care Services Inc
- River Valley Primary Care Services Inc
- Peggy Rosson
- Sheridan Schneider
- Sam R. Shanlever
- John C Urban
- Edward A Vela
All providers in Ratcliff, AR · Nurse Practitioner in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.