Provider Demographics
NPI:1225408057
Name:PUCKETT, SALLY DEE (APRN)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:DEE
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:1 CHILDREN'S WAY
Mailing Address - Street 2:SLOT 844
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-2090
Mailing Address - Fax:501-364-3929
Practice Address - Street 1:1 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2018-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARA004531363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics