Provider Demographics
NPI:1104811157
Name:FORD, MARCIA P (APN CDE)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:P
Last Name:FORD
Suffix:
Gender:F
Credentials:APN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-862-2400
Mailing Address - Fax:870-862-1891
Practice Address - Street 1:600 S TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6990
Practice Address - Country:US
Practice Address - Phone:870-862-2400
Practice Address - Fax:870-862-1891
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01490 ANP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPO1679Medicare UPIN
AR5U975Medicare ID - Type Unspecified