Provider Demographics
NPI:1063842474
Name:VALLEY HARRELL, KATRINA K (RN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:K
Last Name:VALLEY HARRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MCDONOUGH
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72342-2912
Mailing Address - Country:US
Mailing Address - Phone:870-338-8106
Mailing Address - Fax:870-338-3430
Practice Address - Street 1:515 MCDONOUGH
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-2912
Practice Address - Country:US
Practice Address - Phone:870-338-8106
Practice Address - Fax:870-338-3430
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR73587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse