1942643648 NPI number — MRS. JANET GAIL FREEMAN APN

Table of content: MRS. JANET GAIL FREEMAN APN (NPI 1942643648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942643648 NPI number — MRS. JANET GAIL FREEMAN APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
JANET
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAY
Provider Other First Name:
JANET
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942643648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 CORONDELET LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAUMELLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72113-7305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-786-3654
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4300 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-5446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-257-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  A003835 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)