Active NPI
Anita Kay Brackin
- Attendant Care Provider
- Blytheville, AR
National Provider Identifier
1306020128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Attendant Care Provider
- License
- 164582782783
- Practice address
- 440 Rosemary LN
Blytheville, AR 72315-1738 - Phone
- (870) 623-6222
- Fax
- (870) 763-1202
- NPI assigned
- Dec 28, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | 164582782783 | AR | Primary |
Addresses
Primary practice location
440 Rosemary LN
Blytheville, AR 72315-1738
Mailing address
440 Rosemary LN
Blytheville, AR 72315-1738
Phone (870) 623-6222
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 |
|---|---|---|---|
| 164582782783 | AR | MD | Attendant Care Provider |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198800000000",
"number": "1306020128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "440 ROSEMARY LN",
"city": "BLYTHEVILLE",
"state": "AR",
"postal_code": "723151738",
"telephone_number": "870-623-6222",
"fax_number": "870-763-1202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 ROSEMARY LN",
"city": "BLYTHEVILLE",
"state": "AR",
"postal_code": "723151738",
"telephone_number": "870-623-6222",
"fax_number": "870-763-1202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACKIN",
"first_name": "ANITA",
"middle_name": "KAY",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-28",
"last_updated": "2007-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": "AR",
"license": "164582782783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blytheville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.