Active NPI
Carrie Darlene Fendley, APN
- Family Nurse Practitioner
- Benton, AR
National Provider Identifier
1508178955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- A003402
- Practice address
- 620 W South St Ste B
Benton, AR 72015-4235 - Phone
- (501) 860-7150
- Fax
- (501) 860-7166
- NPI assigned
- Jul 13, 2010
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | A003402 | AR | Primary |
Addresses
Primary practice location
620 W South St Ste B
Benton, AR 72015-4235
Mailing address
PO Box 497
Augusta, AR 72006-0497
Phone (870) 347-2534
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 185317758 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1546 | AK | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549843200000",
"number": "1508178955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 497",
"city": "AUGUSTA",
"state": "AR",
"postal_code": "720060497",
"telephone_number": "870-347-2534",
"fax_number": "870-347-2023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 W SOUTH ST STE B",
"city": "BENTON",
"state": "AR",
"postal_code": "720154235",
"telephone_number": "501-860-7150",
"fax_number": "501-860-7166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENDLEY",
"first_name": "CARRIE",
"middle_name": "DARLENE",
"name_prefix": "Mrs.",
"credential": "APN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-13",
"last_updated": "2019-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AR",
"license": "A003402",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "185317758",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Benton, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.