Provider Demographics
NPI:1154411379
Name:RHODES, MICHELE (ADVANCED PRACTICE NU)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:RHODES
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NU
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:HAMILTON
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADVANCED PRACTICE NU
Mailing Address - Street 1:419 E 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71857-2253
Mailing Address - Country:US
Mailing Address - Phone:870-887-3996
Mailing Address - Fax:
Practice Address - Street 1:1501 WEST FIRST STREET
Practice Address - Street 2:ARK DEPARTMENT OF HEALTH AND HUMAN SERVICES
Practice Address - City:PRESCOTT
Practice Address - State:AR
Practice Address - Zip Code:71857
Practice Address - Country:US
Practice Address - Phone:870-887-2004
Practice Address - Fax:870-887-6407
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR440126201Medicaid